2564 resected periampullary adenocarcinomas at a single institution: trends over three decades

He, Jin; Ahuja, Nita; Makary, Martin A.; Cameron, John L.; Eckhäuser, Frederic E.; Choti, Michael A.; Hruban, Ralph H.; Pawlik, Timothy M.; Wolfgang, Christopher L.

doi:10.1111/hpb.12078

Cited by 255 publications

(208 citation statements)

References 35 publications

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“…The most frequent complication of periampullary surgery is pancreatic fistula, which is reported at variable rates in the literature, ranging from 9% and 12% to 29% (13,24,26,28). In the present study, the rate was 23.9%, with no statistically significant betweengroup differences.…”

contrasting

confidence: 42%

Perioperative Synbiotics Decrease Postoperative Complications in Periampullary Neoplasms: A Randomized, Double-Blind Clinical Trial

Sommacal

Bersch

Vitola

et al. 2015

Nutrition and Cancer

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Periampullary neoplasms are rapidly progressive tumors with a poor prognosis and high morbidity and mortality rates, which have a negative influence on patient outcomes. Some probiotics and prebiotics have the ability to protect the intestinal barrier and prevent bacterial translocation, infection, and postoperative complications. We evaluated the use of synbiotics in a prospective, double-blind study of patients undergoing surgery for periampullary neoplasms (PNs) and assessed the effect of these agents on nutritional status, postoperative complications, antibiotic use, length of hospital stay, and mortality. Patients were randomized to receive probiotics and prebiotics-synbiotics--group S [Lactobacillus acidophilus 10, 1 × 10(9)CFU, Lactobacillus rhamnosus HS 111, 1 × 10(9) CFU, Lactobacillus casei 10, 1 × 10(9) CFU, Bifidobacterium bifidum, 1 × 10(9)CFU, and fructooligosaccharides (FOS) 100 mg]--or placebo-controls--group C, twice daily, for a total of 14 days. Risk, clinical status, and postoperative complication rates were assessed. Twenty-three patients were allocated to each group. The incidence of postoperative infection was significantly lower in group S (6 of 23 patients, 26.1%) than in group C (16 of 23 patients, 69.6%) (P = 0.00). Duration of antibiotic therapy was also shorter in group S (mean = 9 days vs. 15 days in group C; P = 0.01). Noninfectious complications were less common in group S (6 of 23 vs. 14 of 23 patients in group C; P = 0.03). Mean length of hospital stay was 12 ± 5 days in group S vs. 23 ± 14 days in group C (P = 0.00). No deaths occurred in group S, whereas 6 deaths occurred in group C (P = 0.02). Perioperative administration of synbiotics reduces postoperative mortality and complication rates in patients undergoing surgery for PNs.

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contrasting

confidence: 42%

Perioperative Synbiotics Decrease Postoperative Complications in Periampullary Neoplasms: A Randomized, Double-Blind Clinical Trial

Sommacal

Bersch

Vitola

et al. 2015

Nutrition and Cancer

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“…Additionally, the local recurrence of the tumour is also rare when compared to local excision even in small ampullary tumours [19] . While overall morbidity of 31.2% and perioperative 90 days mortality of 4.7% in our series well correspond with the published data, and the rate of clinically significant pancreatic fistulas (ISGPF grades B and C) of 8.3% does not exceed the rates reported by other groups [5,20], we reckon this approach rational.…”

Section: Discussionsupporting

confidence: 91%

Preoperative Endoscopic Biliary Drainage May Negatively Impact Survival Following Pancreatoduodenectomy for Ampullary Cancer

Barauskas

Urbonas²,

Smailytė³

et al. 2016

Dig Surg

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Background/Aims: Ampullary carcinoma is a rare tumour with a high resectability rate. There is an increasing body of evidence indicating not only tumour-related factors, but also jaundice influence survival following curative resection. Several modalities for preoperative biliary drainage are available; however, routine preoperative endoscopic biliary drainage (PEBD) is not recommended. There is no sufficient data regarding the impact of PEBD on long-term outcomes. The aim of our study was to identify predictive factors of survival with special regard to PEBD in patients undergoing curative resection for ampullary carcinoma. Patients and Methods: Data from 64 consecutive patients with adenocarcinoma of the papilla of Vater who have been operated on was analysed. Overall survival was defined from the date of surgery to the date of death, or censored at the last patient contact. Survival analysis was determined by means of the Kaplan-Meier method. The significance of the demographic, clinical and histopathologic factors was ascertained by the log-rank test. A Cox proportional hazard model was used to determine independent prognostic factors of survival. Results: Twenty patients (31.2%) underwent PEBD. Univariate analysis revealed tumour-related factors, age over 70, and PEBD to negatively influence survival. Five of them (excluding T stage) were identified as the independent prognosticators, while PEBD appeared to be the most decisive factor. Median survival for patients who underwent PEBD was 25.3 months as compared to 112.9 months for those who did not. In conclusion, PEBD negatively affected long-term outcomes in our patients with resected ampullary carcinoma.

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“…We also demonstrate improved pathologic findings and survival associated with the administration of neoadjuvant therapy between operations. Large series of resected pancreas cancer have reported that the morbidity and mortality are approximately 33-53% and 2-4.4%, respectively (20)(21)(22)(23)(24)(25)(26)(27). Our study demonstrates that the overall morbidity and mortality rates are similar between the re-explored group and R2 resection patients (P=0.605 and P=0.35, respectively).…”

Section: Discussionsupporting

confidence: 58%

Neoadjuvant therapy prior to surgical resection for previously explored pancreatic cancer patients is associated with improved survival

Lü

Soares

et al. 2017

Hepatobiliary Surg. Nutr.

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Background: Patients with pancreatic ductal adenocarcinoma (PDAC) are frequently referred to tertiary centers after unsuccessful attempted resections at other institutions. The outcome of these patients who are ultimately resected is not well understood. Methods:We performed a retrospective review of patients with PDAC who underwent re-exploration between 1995 and 2013 at a single high volume tertiary care institution. We aimed to evaluate the association of neoadjuvant therapy prior to re-exploration on pathologic findings and clinical outcome in previously explored patients with PDAC.Results: Between 1995 and 2013, 50 of the 2,062 patients who were surgically explored underwent pancreatic resection following a previous exploration where they were deemed unresectable. The most common reason for unresectability at initial operation was vascular invasion (80%) and a presumed R2 resection. Thirty-seven (74%) patients received neoadjuvant therapy. Neoadjuvant therapy was associated with improved TNM stage (P=0.002), fewer positive lymph nodes (0 vs. 2, P=0.025), and improved median survival (24 vs. 13 months, P=0.044). Compared to R2 resected patients with PDAC who had not previously been explored, re-explored patients had significantly lower pathologic T and N stages (P<0.001) and a longer median survival (19 vs. 10 months, P<0.001). Conclusions:Patients with PDAC deemed unresectable may warrant re-exploration. Treatment with neoadjuvant therapy between operations is associated with improved pathological stage and survival. In this highly selected group of patients, successful resection is associated with improved survival compared to R2 resections.

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2564 resected periampullary adenocarcinomas at a single institution: trends over three decades

Abstract: There are significant differences among PACs in longterm survival following PD. Although the numbers of patients undergoing safe resection have increased, overall longterm outcomes have not improved significantly.

Cited by 255 publications

References 35 publications

Perioperative Synbiotics Decrease Postoperative Complications in Periampullary Neoplasms: A Randomized, Double-Blind Clinical Trial

Perioperative Synbiotics Decrease Postoperative Complications in Periampullary Neoplasms: A Randomized, Double-Blind Clinical Trial

Preoperative Endoscopic Biliary Drainage May Negatively Impact Survival Following Pancreatoduodenectomy for Ampullary Cancer

Neoadjuvant therapy prior to surgical resection for previously explored pancreatic cancer patients is associated with improved survival

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