Extended pancreatectomy as defined by the ISGPS: useful in selected cases of pancreatic cancer but invaluable in other complex pancreatic tumors

Mitra, Abhishek; Pai, Esha; Dusane, Rohit; Ranganathan, Priya; Desouza, Ashwin; Goel, Mahesh; Shrikhande, Shailesh V.

doi:10.1007/s00423-018-1653-6

Cited by 11 publications

(11 citation statements)

References 44 publications

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“…1). As the unit was evolving into a specialised centre with increasing number of cases, there was gradual incorporation of neoadjuvant protocols, superior mesenteric artery (SMA) first approach, multivisceral and vascular resections in routine practice [25][26][27][28][29][30]. Period B also witnessed the widest and biggest expansion of surgical oncology residency programme for speciality trainees across India.…”

Section: Discussionmentioning

confidence: 99%

Twelve Hundred Consecutive Pancreato‐Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India

et al. 2019

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Background Pancreato-duodenectomy (PD) is a technically challenging operation with significant morbidity and mortality. Over the period of time, Tata Memorial Centre has evolved into a high-volume centre for management of pancreatic cancer. Aim of this study is to report the short-and long-term outcomes of 1200 consecutive PDs performed at single tertiary cancer centre in India. Methods 1200 PDs were performed from 1992 to 2017. Prospectively maintained database was used to retrospectively assess the short-and long-term outcomes.Results Study cohort was divided into periods A and B (500 and 700 patients, respectively). Both groups were comparable for demographic variables. Overall morbidity and mortality in entire cohort were 31.2% and 3.9%, respectively. Period B documented significant reduction in post-operative mortality (5.4% vs 2.8%), post-pancreatectomy haemorrhage (5.8% vs 3%) and bile leaks (3.4% vs 1.3%). However, incidence of delayed gastric emptying and clinically relevant post-operative pancreatic fistula was higher in period B. With median follow-up of 25 months, 3-year overall survival and disease-free survival for patients with pancreatic cancer were 43.7% and 38.7%, respectively, and that for periampullary tumours were 65.9% and 59.4%, respectively. Period B also corresponded with dissemination of technical expertise across diverse regions of India with specialised training of 35 surgeons. Conclusion Our study demonstrates the feasibility of delivering high-quality care in a dedicated high-volume centre even in a country with low incidence of pancreatic cancer with marked disparities in medical care and socioeconomic conditions. Improved outcomes underscore the need to promote regionalisation via a dedicated training programme. Shailesh V. Shrikhande and Rajesh S. Shinde have contributed equally to this manuscript.

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Section: Discussionmentioning

confidence: 99%

Twelve Hundred Consecutive Pancreato‐Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India

et al. 2019

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“…It is obvious that patient with extended resections had significantly high rates of morbidity and mortality after pancreatic surgery. 20,[37][38][39] With regards to arterial resection, data are debatable and tend to consider this procedure for selected cases in expert centres. [40][41][42] Perinel et al showed that in highly selected patients, arterial resection can be carried out during PD with an appropriate and sustained arterial reconstruction technique.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, patients with avoidable deaths tended to occur at an earlier stage, to have more blood loss, to require longer operative time, to show more surgical complications and patients were more likely to die within 30 days after pancreatectomy. It is obvious that patient with extended resections had significantly high rates of morbidity and mortality after pancreatic surgery 20,37–39 . With regards to arterial resection, data are debatable and tend to consider this procedure for selected cases in expert centres 40–42 .…”

Section: Discussionmentioning

confidence: 99%

Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study)

et al. 2021

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Objectives: Analyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate. Background: Despite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved. Methods: All patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death. Results: Among the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality. Conclusions: One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.

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“…Anterior and posterior RAMPS were defined as reported by Strasberg et al [5][6][7] Extended resections were defined as en-bloc resection of a neighboring organ such as the stomach or colon. 18 Postoperative course was classified prospectively at discharge, according to the Clavien-Dindo Classification (CDC). 19 Complications graded >IIIa, were considered severe.…”

Section: Thismentioning

confidence: 99%

Minimally invasive versus open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma: an entropy balancing analysis

Ricci,

Kauffmann,

Pagnanelli

et al. 2024

HPB

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Extended pancreatectomy as defined by the ISGPS: useful in selected cases of pancreatic cancer but invaluable in other complex pancreatic tumors

Cited by 11 publications

References 44 publications

Twelve Hundred Consecutive Pancreato‐Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India

Twelve Hundred Consecutive Pancreato‐Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India

Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study)

Minimally invasive versus open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma: an entropy balancing analysis

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