Evolution of pancreatoduodenectomy in a tertiary cancer center in India: Improved results from service reconfiguration

Shrikhande, Shailesh V.; Barreto, Savio George; Somashekar, B.A.; Suradkar, Kunal; Shetty, Guruprasad; Talole, Sanjay; Sirohi, Bhawna; Goel, Mahesh; Shukla, Parul J.

doi:10.1016/j.pan.2012.11.302

Cited by 64 publications

(48 citation statements)

References 61 publications

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“…We can only conjecture that this may be related to the other important variable in improving lymph node yield, the diligence of the pathologist [27]. The development of disease-centric management groups comprising organ/disease-specific, dedicated surgeons and pathologists, as has been the policy at our institution, will help clarify these aspects in the near future [28]. …”

Section: Discussionmentioning

confidence: 99%

D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

et al. 2013

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BackgroundPatients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature.MethodsAnalysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperative outcomes and histopathological responses to NACT were analyzed. The data is presented and compared to a cohort of patients undergoing upfront surgery in the same time period.ResultsIn this study, 139 patients (42 female and 97 male patients, median age 53 years) with gastric adenocarcinoma received NACT. Chemotherapy-related toxicity was noted in 32% of patients. Of the 139 patients, 129 underwent gastrectomy with D2 lymphadenectomy, with 12% morbidity and no mortality. Major pathological response of primary tumor was noted in 22 patients (17%). Of these 22 patients, lymph node metastases were noted in 12 patients. The median blood loss and lymph node yield was not significantly different to the 62 patients who underwent upfront surgery. Patients who underwent upfront surgery were older (58 vs. 52 years, P <0.02), had a higher number of distal cancers (63% vs. 82%, P <0.015) and a longer hospital stay (11 vs. 9 days, P <0.001).ConclusionsPerioperative outcomes of gastrectomy with D2 lymphadenectomy for locally advanced, resectable gastric cancer were not influenced by NACT. The number of lymph nodes harvested was unaltered by NACT but, more pertinently, metastases to lymph nodes were noted even in patients with a major pathological response of the primary tumor. D2 lymphadenectomy should be performed in all patients irrespective of the degree of response to NACT.

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Section: Discussionmentioning

confidence: 99%

D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

et al. 2013

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“…The Tata Memorial Hospital experience on PD over the past two decades is shown in Table 2 [5]. The overall post-operative morbidity and mortality following PD has been 31.7 % and 4.3 % respectively.…”

Section: The Tata Memorial Hospital Experiencementioning

confidence: 99%

“…The high mortality of nearly 25 % following pancreatoduodenectomy (PD) has now been reduced to less than 5 % [1][2][3][4][5] and even zero in some centres of excellence [6,7]. However, the morbidity statistics after PD remain worrisome with a reported range of 25-50 % [6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

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“…The previous work published from the centre observed that pancreatic, gastric and colorectal cancer resections were performed on a young population with outcomes comparable to world standards [4][5][6][7][8] . However, they reflected the susceptibility of the Indian population to cancer at an age that is two decades younger (median age approximately 50-55 years) compared to high-incidence areas in the West and Far East.…”

Section: Introductionmentioning

confidence: 89%

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Batra¹,

Suradkar²,

Talole

et al. 2016

Dig Surg

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Background: There are no data on surgical outcomes of major gastrointestinal cancer resections in the expanding Indian oncogeriatric population. Methods: A prospective database of patients who underwent major gastrointestinal cancer resections during varying time periods (2006-2014) was analyzed retrospectively. Results: Two thousand six hundred and forty three patients with a median age of 53 were analyzed. Four hundred and seventy two (17.9%) patients were aged ≥65 years and 235 (8.9%) patients were ≥70 years. Mortality rates were not significantly higher in the elderly (≥65 years) or the very elderly (≥70 years) when compared to younger controls, being 2.8 vs. 1.6% (p = 0.09) and 3.0 vs. 1.7% (p = 0.162) respectively. Overall morbidity was similar for patients ≥65 or <65 years (24.2 vs. 21.7%, p = 0.253), but was higher in patients ≥70 years (29.8 vs. 21.4%, p = 0.003). The incidence of severe complications, however, was not significantly greater in this age group (13.2 vs. 12.5%, p = 0.74). Conclusions: Major gastrointestinal cancer resections in the elderly Indian population, though uncommon, are safe when performed at experienced high volume centres. These results should serve as a starting point for the gradual development of dedicated oncogeriatric programs in the Indian subcontinent.

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Evolution of pancreatoduodenectomy in a tertiary cancer center in India: Improved results from service reconfiguration

Cited by 64 publications

References 61 publications

D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

Pancreatoduodenectomy - Preventing Complications

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

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