Completion pancreatectomy in the acute management of pancreatic fistula after pancreaticoduodenectomy: a systematic review and qualitative synthesis of the literature

Bressan, Alexsander K.; Wahba, Michael; Dixon, Elijah; Ball, Chad G.

doi:10.1016/j.hpb.2017.08.036

Cited by 30 publications

(36 citation statements)

References 21 publications

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“…Since that time total pancreatectomy was abandoned. As an alternative, following type C Postoperative Pancreatic Fistula (POPF), the pancreatic remnant was simply disconnected and drained in an effort to preserve pancreatic hormonal function [5,29]. Overall Survival in the current series was less than reported elsewhere [30] Survival Function and is likely due to a combination of the high perioperative mortality and lack of adjuvant therapy.…”

Section: Discussionmentioning

confidence: 68%

“…Whether that can ever be achieved remains to be seen. Given the morbidity rates including the fact that the pancreatic specific rates are similar to those reported elsewhere, it would seem likely that the reason for the excess mortality is due to failure to rescue [5,[22][23][24][25]. This poses challenges on how to improve this aspect of perioperative care especially when access to interventional radiology is limited.…”

Section: Discussionmentioning

confidence: 97%

“…Resection is the treatment of choice for periampullary tumors, and in those with malignancy, the addition of adjuvant chemotherapy has been shown to improve survival [1][2][3][4]. However, Pancreaticoduodenectomy (PD) is associated with high morbidity and mortality, especially in low volume centers [5][6][7][8]. In countries with a well-resourced healthcare system, there has been a shift to the centralization of PD as an effort to reduce perioperative mortality and to improve long term outcomes [6,9,10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A “Hub and Spoke” Model for Pancreaticoduodenectomy across the Indonesian Archipelago

Lalisang

Mazni

Matondang

2019

Indonesian Journal of Cancer

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Background: Pancreaticoduodenectomy (PD) is associated with major morbidity and mortality especially in low volume centers. A centralized model is not suitable for Indonesia, due to its geographical characteristics and the underlying structure of its health funding. As an alternative, an outreach program was developed and delivered by a dedicated hepatopancreatobiliary (HPB) team. The aim of this study was to describe the outcomes of such approach. Methods: A retrospective study of all patients undergoing Pancreaticoduodenectomy or total pancreatectomy by a single HPB team was performed. A “hub and spoke” model /decentralization strategy was used to deliver the care between a tertiary center and eight peripheral centers. Patient demographics, system measures, and outcomes were collected. Results: A total of 213 patients were identified as undergoing a resection within the period of 1993–2017. A total of 47 resections (22%) were performed at a peripheral center. The median age was 51 years and 91(46%) of patients had ampullary carcinoma. The perioperative mortality was 17% but improved over time. Only 19/198 (9.5%) patients with the malignant disease received adjuvant therapy. The median (95%CI) survival for patients with pancreatic and ampullary cancer was 12 (9-15) and 24 (14-34) months respectively. Conclusions: A hub and spoke model as a decentralization strategy for managing patients with peri-ampullary tumors can lead to an improvement in access and outcomes. However further work is required if they are to achieve outcomes achieved by international high-volume centers within centralization programs.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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A “Hub and Spoke” Model for Pancreaticoduodenectomy across the Indonesian Archipelago

Lalisang

Mazni

Matondang

2019

Indonesian Journal of Cancer

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“…Nach einer Pankreaskopfresektion ist eine Neuanlage einer insuffizienten Pankreasanastomose nur in Ausnahmefällen möglich. Häufig wird im Rahmen der Operation zur Behebung der kritischen Situation eine Salvage-Restpankreatektomie durchgeführt, die jedoch laut Literatur mit einer Mortalität von 42 % einhergeht [11]…”

Section: Caveunclassified

Komplikationsmanagement nach Pankreaseingriffen

Demir¹,

Demir²,

Frieß³

2020

Allgemein- und Viszeralchirurgie up2date

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“…A clinical grading system for POPF was introduced by the International Study Group for Pancreatic Fistula (ISGPF) to be associated with the severity of postoperative complications (5). It is divided into three grades, as follows: Grade A, grade B and grade C. Lowering the incidence rates of POPF effectively, in particular grade B and/or grade C POPF (5,6), is critical to decrease the degree of postoperative intervention treatment, reduce hospital stays and mortality rates (5). Of all the surgical steps in PD, pancreatic-enteric reconstruction is recognized as one of the most critical for postoperative recovery (7), thus the ideal pancreatic-enteric reconstruction must be convenient yet reliable.…”

Section: Introductionmentioning

confidence: 99%

Application of a novel embeddedness‑like pancreaticojejunostomy anastomosis technique used in pancreaticoduodenectomy

Zhang

et al. 2018

Oncol Lett

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Optimized pancreaticojejunostomy anastomosis was used to investigate the effects on the incidence rate of postoperative complications in pancreaticoduodenectomy. The data of 250 patients who underwent pancreaticoduodenectomy between August 2011 and December 2015 were analyzed; all surgery was performed by a single team. The first 100 surgeries were performed using traditional pancreaticojejunostomy anastomosis, whereas the next 150 patients underwent novel pancreaticojejunostomy anastomosis (the experimental group). General information, disease status and the occurrence rate of postoperative complications [postoperative pancreatic fistula (POPF), biliary leakage, delayed gastric emptying, bleeding and mortality] within 30 days of surgery were observed. In the first group, 56 patients had POPF (56%), the proportion of grades A, B and C was 44% (n=44), 9% (n=9) and 3% (n=3), respectively; in the experimental group, 30 patients had POPF (20%), the proportion of grades A, B and C was 14.67% (n=22), 5.33% (n=8) and 0%, respectively. Furthermore, in the experimental group, none of the patients exhibited postoperative bleeding or succumbed during surgery. The application of the novel embeddedness-like pancreaticojejunostomy anastomosis technique in pancreaticoduodenectomy was safe and effective, and may reduce the incidence of POPF in future.

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Completion pancreatectomy in the acute management of pancreatic fistula after pancreaticoduodenectomy: a systematic review and qualitative synthesis of the literature

Abstract: Emergency surgery for postoperative pancreatic fistula should only be considered after expert consultation. CP carries a high risk of mortality, and it is most commonly recommended for a selected subgroup of patients with locally complicated fistula.

Cited by 30 publications

References 21 publications

A “Hub and Spoke” Model for Pancreaticoduodenectomy across the Indonesian Archipelago

A “Hub and Spoke” Model for Pancreaticoduodenectomy across the Indonesian Archipelago

Komplikationsmanagement nach Pankreaseingriffen

Application of a novel embeddedness‑like pancreaticojejunostomy anastomosis technique used in pancreaticoduodenectomy

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