Outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing robotic (RPD) or open pancreaticoduodenectomies (OPD): a propensity score-weighted survival analysis

Mejía, Alejandro; Shah, Jimmy; Vivian, Elaina; Beard, Robyn; Acharya, Priyanka; Gutierrez, Juan Carlos Barrera

doi:10.1007/s11701-022-01510-w

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…Hyperbilirubinemia can lead to severe internal environmental disorders and multiple complications, including impaired immune response, nutrient malabsorption, biliary tract infection, liver dysfunction, coagulation dysfunction, and even death. Studies on the prognostic effects of high TBIL have been reported [23][24][25]. In a retrospective study up to 9 years after PD surgery, it was found that postoperative increases in TBIL were associated with poor survival prognosis in patients [26].…”

Section: Discussionmentioning

confidence: 99%

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Wang,

Qin,

Zhang

et al. 2024

Preprint

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Background: The prevalence of clinically relevant postoperative pancreatic fistulas (CR-POPF) following pancreaticoduodenectomy (PD) is relatively high. Most studies on the prediction of CR-POPF are limited to pre-operation, while there are few indicators to predict CR-POPF in the early postoperative period. The purpose of this study was to investigate the value of total bilirubin (TBIL) level on postoperative day 3 in predicting CR-POPF after PD. Methods: The clinical data of 170 patients who underwent PD in our team from January 2015 to October 2022 was retrospectively analyzed into two groups: the CR-POPF group with a grade B or C pancreatic fistula (n = 37), the no CR-POPF group with a non-pancreatic fistula, and the biochemical fistula patients (n = 133). Univariate and multivariate analyses were used to screen the potential indicators for predicting CR-POPF. The predictive value of risk factors was assessed by area under the ROC curve. Results: Preoperative variables, including hemoglobin (Hb), C-reactive protein (CRP), TBIL, albumin (ALB), pancreatic texture, hemorrhage, duct diameter, and TBIL on postoperative day 3, were identified as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) (p < 0.001). The multivariate logistic regression analysis revealed that pancreatic texture (p = 0.004), postoperative TBIL (p<0.001), and preoperative CRP (p = 0.048) were identified as independent risk variables. To predict CR-POPF, the area under the curve (AUC) of pancreatic texture, TBIL on the third day of surgery, and preoperative CRP were found to be 0.607, 0.824, and 0.726, respectively. Conclusion: The TBIL level on postoperative day 3 is a significant predictor of CR-POPF after PD which can accurately predict CR-POPF.

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Section: Discussionmentioning

confidence: 99%

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Wang,

Qin,

Zhang

et al. 2024

Preprint

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“…It is also imperative to recognize the impact of postoperative markers that have demonstrated significant associations with mortality. Tumor size, tumor grade, residual tumor or margin involvement, and the presence of lymph node metastases were identified as critical determinants influencing patient outcomes after pancreatic resection [ 17 , 18 ]. Furthermore, postoperative variables, such as the International Study Group of Pancreatic Surgery-defined complications, and the utilization of adjuvant therapy, exert notable impacts on postoperative mortality rates [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tumor size, tumor grade, residual tumor or margin involvement, and the presence of lymph node metastases were identified as critical determinants influencing patient outcomes after pancreatic resection [ 17 , 18 ]. Furthermore, postoperative variables, such as the International Study Group of Pancreatic Surgery-defined complications, and the utilization of adjuvant therapy, exert notable impacts on postoperative mortality rates [ 18 ]. Despite the relevance of these postoperative factors, the current study focused on identifying easily accessible and non-invasive preoperative markers.…”

Section: Discussionmentioning

confidence: 99%

Albumin-Bilirubin (ALBI) Score and Systemic Immune-Inflammation Indexes Used As Pretreatment Outcome Predictors in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Robotic or Open Whipple Procedures: A Logistic Regression Analysis

Mejia,

Vivian,

Shah

et al. 2023

Cureus

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Background Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer (PC) in the United States. In patients with resectable PC, identification of pretreatment biomarkers before surgery can help in the decision-making process by weighing the benefits of neo-adjuvant therapy, surgical procedure, and adjuvant therapy. The purpose of this study was to determine if the albumin-bilirubin (ALBI) score and immune-inflammatory marker levels can be used in combination as pretreatment predictors of mortality risk in patients undergoing the Whipple procedure (alternatively, pancreatoduodenectomy (PD)) for PDAC. Methods This retrospective study included 115 patients with PDAC who underwent open or robotic Whipple procedures between January 2013 and December 2022 at a single tertiary medical center. Logistic regression analysis was used to find the association between predictors and mortality. Machine learning algorithms were used to calculate the performance of the different models. Results Bivariate analysis showed that the variables “sex” and “body mass index (BMI)” had a potential association with mortality, although statistical significance was not achieved for sex (p = 0.07). Patients with BMIs >25 kg/m 2 had a higher risk of mortality compared to patients with BMIs ≤24.9 kg/m 2 (odds ratio (OR) = 2.2, 95% CI = 1.03-4.8, p = 0.04). Higher (more positive) ALBI scores (>-2.24) were also associated with increased mortality risk (OR = 4.6, 95% CI = 2-10.5, p = 0.0003). When the cutoff values of the inflammatory markers were used to categorize these variables, values greater than the cutoff values were associated with an increased risk of mortality. In the multivariate logistic regression model, an ALBI score >-2.24 (OR = 4.3, 95% CI = 1.8-10.3, p = 0.0008), neutrophil-to-lymphocyte ratio (NLR) >3.5 (OR = 3.3, 95% CI = 1.4-7.9, p = 0.007), and being a woman (OR = 2.6, 95% CI = 1.1-6.4, p = 0.03) remained influential predictors of increased mortality (c value = 0.77). Conclusion The ALBI score and the NLR are easily accessible markers; their use, combined with a patient’s sex, can provide useful pre-surgical information regarding mortality risk after PD. This can aid in treatment planning as well as expedite decisions about the type of Whipple procedure, adjuvant therapy, and surveillance, which can subsequently improve a patient’s outcomes and survival.

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“…Pancreatic resection can be performed as an open, minimally invasive laparoscopic, or robot-assisted procedure. In the data published to date, no significant differences in overall morbidity or mortality can be seen between the procedures [19][20][21]. While open surgery is shorter, minimally invasive procedures tend to have advantages with respect to less blood loss, fewer relevant pancreatic fistulas, and a shorter hospital stay [21,22].…”

Section: Surgerymentioning

confidence: 99%

“…Die Pankreasresektion kann offen, minimal-invasiv laparoskopisch oder roboterassistiert durchgeführt werden. Zwischen den Verfahren lassen sich für die Pankreaskopfresektion anhand der bisher veröffentlichten Daten keine signifikanten Unterschiede der Gesamtmorbidität oder Mortalität ableiten [19][20][21]. Während die offene Operation eine kürzere Operationszeit hat, zeigen die minimal-invasiven Verfahren tendenziell Vorteile hinsichtlich eines geringeren Blutverlustes, weniger relevanten Pankreasfisteln und einer kürzeren Krankenhausverweildauer [21,22].…”

Section: Chirurgieunclassified

The postsurgical pancreas

Fischbach,

Peller,

Perez

et al. 2024

Rofo

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Background Partial pancreatic resections are among the most complex surgical procedures in visceral tumor medicine and are associated with a high postoperative morbidity with a complication rate of 40–50 % of patients even in specialized centers. Methods Description of typical surgical resection procedures and the resulting postoperative anatomy, typical normal postoperative findings, common postoperative complications, and radiological findings. Results and conclusion CT is the most appropriate imaging technique for rapid and standardized visualization of postoperative anatomy and detection of clinically suspected complications after partial pancreatic resections. The most common complications are delayed gastric emptying, pancreatic fistula, acute pancreatitis, bile leakage, abscess, and hemorrhage. Radiologists must identify the typical surgical procedures, the postoperative anatomy, and normal postoperative findings as well as possible postoperative complications and know interventional treatment methods for common complications. Key points: Citation Format

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Outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing robotic (RPD) or open pancreaticoduodenectomies (OPD): a propensity score-weighted survival analysis

Cited by 6 publications

References 33 publications

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Albumin-Bilirubin (ALBI) Score and Systemic Immune-Inflammation Indexes Used As Pretreatment Outcome Predictors in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Robotic or Open Whipple Procedures: A Logistic Regression Analysis

The postsurgical pancreas

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