Feasibility, Morbidity and Mortality in Two Hundred Consecutive Cases of Pancreaticogastrostomy After Pancreaticoduodenectomy

Herrera, Javier; Zazpe, C.; Sánchez, Pablo Menéndez; Tarifa, Antonio; Eguaras, Inés; Lera, José Miguel

doi:10.1016/j.cireng.2019.10.012

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…With the development of medical technology, the introduction of various advanced instruments and equipment, the continuous optimization of perioperative management, and the tendency for centralization in pancreaticoduodenectomy, the mortality rate is approximately 5% [39,40], and even in some high-volume centers, the mortality rate has even been reduced to 1-2% [41,42]. However, the rate of overall postoperative complications is still as high as 30%-60% [43][44][45]. In particular, complications such as pancreatic fistula, delayed gastric emptying, wound infections, and abdominal abscesses prolong the length of hospital stay and increase the risk for readmission, reoperation, and even death.…”

Section: Discussionmentioning

confidence: 99%

The Safety and Feasibility of Enhanced Recovery after Surgery in Patients Undergoing Pancreaticoduodenectomy: An Updated Meta-Analysis

Sun

Wang

Mao

et al. 2020

BioMed Research International

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Background. Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary, evidence-based approach to care for surgical patients and aims at optimizing the perioperative management and outcomes. The ERAS approach was first implemented in colorectal surgery patients; however, the reported applications in pancreatoduodenectomy patients are limited. In recent years, studies on ERAS for patients undergoing pancreaticoduodenectomy have been published. The accumulation of new randomized controlled trials and high-quality case-control studies stimulated us to update the analysis. Our study comprehensively collected data to provide the best evidence summary for the clinic. Aim. To evaluate the safety and feasibility of enhanced recovery after surgery in the perioperative management of pancreatoduodenectomy patients. Methods. A systematic literature search of PubMed, Embase, and the Cochrane Library was performed up to July 2019. All randomized controlled trials and case-control studies that applied ERAS for patients undergoing pancreaticoduodenectomy were considered for inclusion in this study. The patients were divided into two groups: patients who received the ERAS perioperative management approach were defined as the ERAS group and patients who received the traditional perioperative management approach were defined as the control group. All statistical analyses were conducted using the Revman5.3 software, and the outcomes were calculated as odds ratios or weighted mean differences with their corresponding 95% confidence intervals. A funnel plot was created to assess publication bias. Subgroup and sensitivity analyses were performed to explore the sources of heterogeneity. Results. A total of 20 studies involving 3613 patients (1914 patients in the ERAS group vs. 1699 patients in the control group) were included in this study. Among the 20 studies, 4 were randomized controlled trials, and 16 were case-control studies. The overall postoperative complication rate was significantly lower in the ERAS group (OR=0.62, 95% CI: 0.53-0.74, P<0.00001) than in the control group. In addition, the minor complication rate (Clavien-Dindo I-II) was also lower in the ERAS group (OR=0.70, 95% CI: 0.58-0.86, P=0.0005). The patients in the ERAS group had a lower incidence of delayed gastric emptying (OR=0.51, 95% CI: 0.42-0.63, P<0.00001) and shorter length of hospital stay (WMD=−4.27, 95% CI: -4.81~-3.73, P<0.00001) than in the control group. The rates of pancreatic fistula (regardless of Grade A/B/C), wound infections, abdominal abscesses, readmission, reoperation, and morbidity were not significantly different between the two groups. Conclusion. The ERAS approach is safe and effective in the perioperative management of patients undergoing pancreaticoduodenectomy and helps to accelerate the postoperative recovery and improve prognosis.

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Section: Discussionmentioning

confidence: 99%

The Safety and Feasibility of Enhanced Recovery after Surgery in Patients Undergoing Pancreaticoduodenectomy: An Updated Meta-Analysis

Sun

Wang

Mao

et al. 2020

BioMed Research International

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“…Whipple pancreaticoduodenectomy still remains only surgical choice for periampullary tumors and despite advances in surgical techniques, postoperative morbidity and mortality are high even today ( 7,8). Mortality rate after PD has decreased drastically especially in high volume surgical centers over the years (<1,5%) but morbidity remains still high and in some low volume surgical centers range to 50-60 % ( 9 , 10 ). In our study morbidity rate was 55% and mortality rate was 18% which is still high and it correlates with our small annual number of PD surgeries.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Hypoalbuminemia as a Predictor of Severe Postoperative Complications in Patients Undergoing Whipple Pancreatoduodenectomy

Ahmetasevic,

Hasukic,

Agic

et al. 2023

Med Arch

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Background: Pancreaticoduodenectomy (PD) known as Whipple procedure is still one of the most complex abdominal surgeries used for treatment of periampullary tumors. PD is often followed with postoperative complications (pancreatic, biliar or intestinal fistula, haemorrhage, intraabdominal abscess, delayed gastric empting. Severe postoperative complications (SPC) can be reason for reoperation and reason of bad outcome of treatment and life treathening condition. Objective: To investigate predicitive value of preoperative hypoalbuminemia for severe postoperative complications (SPC) in patients who have undergone Whipple pancreaticoduodenetomy (PD). However, no similiar study has been ever reported from our country until now. Methods: In this retrospective-prospective study, 100 patients who have had Whipple pancreaticoduodenectomy for malignant periampullary tumors at the Department for Surgery of University Clinic Center Tuzla, Bosnia and Herzegovina were enrolled, from january of 2009 to decembre of 2021. All patients were preoperatively analysed according to serum albumine levels and presensce of hypolabuminemia (serum albumine levels <32g/l). Serum albumine biochemical test were done 1-2 days preoperatively. Clavien Dindo classification was used for determination patients with SPC. Patients who did not have SPC belonged to (I-II) Clavien Dindo group of patients while those who had SPC belonged to( III-V) Clavien Dindo group of patients. Results: Out of 100 patients who have undergone pancreaticoduodenetomy, in 55 (55%) patients postoperative complications were noticed. Mortality rate was 18 (18%) and reoperation has been done in 20 cases (20%). SPC were noticed in 19 patients and most often were: delayed gastric emptying (20%), pancreatic fistula (13%) and intraabdominal collections (9%). Hypoalbuminemic patients had a significantly higher rate of severe postoperative complications ( p<0.05). Using hypoalbuminemia-SPC correlation analaysis, there is confirmed statistically significant correlation between hypoalbuminemia and SPC (ρ= 0.236; p<0.05). Conclusion: Preoperative hypoalbuminemia can be used as predictor and prognostic factor for severe postoperative complications after Whipple pancreaticoduodenectomy. Identification and optimization of serum albumin level prior to Whipple pancreatoduodenectomy may improve surgical outcomes.

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“…Pancreaticoduodenectomy (PD) is a valid surgical procedure for selected patients with pancreatic head and periampullary malignant space‐occupying lesions as well as some pancreatic chronic inflammatory mass. Due to the wide range of surgical resection and a variety of alimentary tract reconstruction establishment, the technique is usually accompanied by a relatively high incidence of postoperative complications, ranging from 45% to 60% 1 …”

Section: Introductionmentioning

confidence: 99%

Effect of Billroth‐II versus Roux‐en‐Y reconstruction for gastrojejunostomy after pancreaticoduodenectomy on delayed gastric emptying: A meta‐analysis of randomized controlled trials

Xiao

Hao

Yang

et al. 2020

J Hepato Biliary Pancreat

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Background/Purpose: Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD). The aim of the present metaanalysis was to evaluate the effect of Billroth-II(B-II) versus Roux-en-Y (R-Y) reconstruction for gastrojejunostomy on DGE after PD. Methods: A systematic literature search was performed using the electronic database MEDLINE (via PubMed and OVID), EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) of the Cochrane Library to select pertinent randomized controlled trials (RCTs) on this topic from January 1990 to January 2020.The primary outcome was identified as postoperative DGE. Subgroup analysis was established to compare the incidence of grade B and C DGE. Software Revman 5.3 was used for the statistical analysis, summary statistics were calculated using fixed effect model or random effect model. Results: Five RCTs including a total of 612 patients were eligible for this metaanalysis. The incidence of grade B and C DGE was significantly lower with the B-II reconstruction than with the R-Y reconstruction (8.0% vs. 14.8%, OR = 0.49, 95% CI: 0.26-0.95, P = 0.03) and the B-II reconstruction took a shorter operation time (WMD=−7.18, 95% CI: [−13.09, −1.27], P = 0,02). No statistically significant difference was found between the two reconstruction methods in terms of the incidence of postoperative pancreatic fistula (POPF), bile leak, intra-abdominal abscess, postoperative pneumonia and the length of postoperative hospital stay. Conclusions: B-II reconstruction after PD has a lower incidence of grade B and C DGE and shorter operation time compared with R-Y reconstruction.

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Feasibility, Morbidity and Mortality in Two Hundred Consecutive Cases of Pancreaticogastrostomy After Pancreaticoduodenectomy

Cited by 3 publications

References 22 publications

The Safety and Feasibility of Enhanced Recovery after Surgery in Patients Undergoing Pancreaticoduodenectomy: An Updated Meta-Analysis

The Safety and Feasibility of Enhanced Recovery after Surgery in Patients Undergoing Pancreaticoduodenectomy: An Updated Meta-Analysis

Preoperative Hypoalbuminemia as a Predictor of Severe Postoperative Complications in Patients Undergoing Whipple Pancreatoduodenectomy

Effect of Billroth‐II versus Roux‐en‐Y reconstruction for gastrojejunostomy after pancreaticoduodenectomy on delayed gastric emptying: A meta‐analysis of randomized controlled trials

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