Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: A matched case-control study

Busquets, Juli; Fabregat, J.; Borobia, Francisco G.; Jorba, Rosa; Valls, Carlos; Serrano, Teresa; Ramos, Emilio; Peláez, Núria; Rafecas, A

doi:10.1007/s00595-008-4038-6

Cited by 30 publications

(19 citation statements)

References 30 publications

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“…a ). Sensitivity analyses of studies that applied the ISGPF definition of POPF and of clinically relevant POPF (grade B/C) confirmed the results of the primary meta‐analysis (ISGPF definition: 12 studies, OR 2·15, 1·30 to 3·57, P = 0·003, I 2 = 33 per cent; B/C POPF: 7 studies, OR 1·93, 1·14 to 3·27, P = 0·01, I 2 = 0 per cent). In contrast, when only high‐volume studies with more than 20 enucleations and at least four enucleations per year were analysed, the result no longer attained significance (4 studies; OR 1·72, 0·87 to 3·38; P = 0·12, I 2 = 49 per cent) ( Fig.…”

Section: Resultssupporting

confidence: 58%

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Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms

Hüttner

Koessler-Ebs

Hackert

et al. 2015

British Journal of Surgery

127

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Background: Pancreatic enucleation is a tissue-sparing approach to pancreatic neoplasms and may result in better postoperative pancreatic function than standard pancreatic resection. The objective of this review was to compare the postoperative outcome after pancreatic enucleation versus standard resection.Methods: MEDLINE, Embase and the Cochrane Library were searched systematically until February 2015 to identify studies comparing the outcome of enucleation versus standard resection for pancreatic neoplasms. After critical appraisal, meta-analysis was performed and the findings were presented as odds ratios or weighted mean differences with corresponding 95 per cent c.i.Results: Twenty-two observational studies (1148 patients) were included. Duration of surgery (P < 0⋅001), blood loss (P < 0⋅001), length of hospital stay (P = 0⋅04), and postoperative endocrine (P < 0⋅001) and exocrine (P = 0⋅01) insufficiency were lower after enucleation than after standard resection. Mortality (P = 0⋅44), overall complications (P = 0⋅74), reoperation rate (P = 0⋅93) and delayed gastric emptying (P = 0⋅15) were not significantly different between the two approaches. The overall rate of postoperative pancreatic fistula (POPF) was higher after enucleation than after standard resection (P < 0⋅001). However, the raised POPF rate did not result in higher mortality or overall morbidity. Sensitivity analysis of high-volume studies (total of more than 20 enucleations and more than 4 per year) showed that, in specialized centres, enucleation can be performed with no increased risk of POPF (P = 0⋅12). Conclusion:Compared with standard resection, pancreatic enucleation can be performed effectively and with comparable safety in high-volume institutions. Enucleation should be considered instead of standard resection for selected pancreatic neoplasms.

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Section: Resultssupporting

confidence: 58%

“…However, the primary data did not distinguish between POPF rates after enucleation in the body/tail versus head/uncinate, so this subgroup analysis could not be conducted. Baseline comparability was assessed in all studies, but in 12 it was limited owing to sparse baseline data.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms

Hüttner

Koessler-Ebs

Hackert

et al. 2015

British Journal of Surgery

127

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“…2 Different technical aspects related to PD (including pylorus preservation, the type of pancreatic anastomosis, and the route of gastroenteric anastomosis) have not been clarifi ed in the current literature, and still represent a great matter of controversy among pancreatic surgeons. [3][4][5][6] The treatment of borderline resectable to locally advanced PDAC is even more controversial: extended resections have been proposed by different authors, but a long-term follow-up has never demonstrated a substantial improvement in the overall survival. However, a growing number of locally advanced patients are being downstaged by preoperative chemotherapy and later successfully resected, but clear information on the long-term survival is still lacking.…”

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy for pancreatic cancer: The Verona experience

Malleo¹,

Marchegiani²,

Salvia³

et al. 2011

Surg Today

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Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the Western world. The current treatment is multimodal, and in resectable patients radical surgery represents the key-step toward long-term survival. Pancreaticoduodenectomy (PD) is the most widely performed operation, because the majority of ductal carcinomas arise in the head of the pancreas. Once considered extremely hazardous, PD has evolved into a safe procedure, with mortality below 5% and morbidity rates in the range from 20% to 60% at high-volume centers. Verona is regarded as one of the most prominent institutions for pancreatic surgery in Europe. More than 5500 patients with pancreatic diseases have been managed, and the surgical case load has increased substantially, with more than 1350 PDs performed. This review discusses this center's experience in surgical treatment of pancreatic head cancer. Furthermore, the preliminary results of radiofrequency thermal ablation of locally advanced ductal cancer are presented.

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“…[1][2][3][4] A recent clinical trial has reported that although organ-preserving pancreatic surgery potentially decreased the incidence of postoperative delayed gastric emptying in comparison with a pancreatoduodenectomy, there were no signifi cant differences between the two groups in the incidence of pancreatic fi stulas or other complications. 5 Despite recent progress in understanding the immune conditions of abdominal sepsis, the postoperative incidence of septic complications after major visceral surgery remains high. [1][2][3][4] During the past decade, a number of experimental and clinical studies have provided evidence that surgical and trauma injury markedly affects the immune system, including both the specifi c and the nonspecifi c immune responses.…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression following surgical and traumatic injury

et al. 2010

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Severe sepsis and organ failure are still the major causes of postoperative morbidity and mortality after major hepatobiliary pancreatic surgery. Despite recent progress in understanding the immune conditions of abdominal sepsis, the postoperative incidence of septic complications after major visceral surgery remains high. This review focuses on the clinical and immunological parameters that determine the risk of the development and lethal outcome of postoperative septic complication following major surgery and trauma. A review of the literature indicates that surgical and traumatic injury profoundly affects the innate and adaptive immune responses, and that a marked suppression in cell-mediated immunity following an excessive inflammatory response appears to be responsible for the increased susceptibility to subsequent sepsis. The innate and adaptive immune responses are initiated and modulated by pathogen-associated molecular-pattern molecules and by damage-associated molecular-pattern molecules through the pattern-recognition receptors. Suppression of cell-mediated immunity may be caused by multifaceted cytokine/inhibitor profiles in the circulation and other compartments of the host, excessive activation and dysregulated recruitment of polymorphonuclear neutrophils, induction of alternatively activated or regulatory macrophages that have anti-inflammatory properties, a shift in the T-helper (Th)1/Th2 balance toward Th2, appearance of regulatory T cells, which are potent suppressors of the innate and adaptive immune system, and lymphocyte apoptosis in patients with sepsis. Recent basic and clinical studies have elucidated the functional effects of surgical and traumatic injury on the immune system. The research studies of interest may in future aid in the selection of appropriate therapeutic protocols.

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Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: A matched case-control study

Abstract: Surgical techniques for preserving pancreatic tissue are effective for carefully selected patients with benign pancreatic disorders.

Cited by 30 publications

References 30 publications

Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms

Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms

Pancreaticoduodenectomy for pancreatic cancer: The Verona experience

Immunosuppression following surgical and traumatic injury

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