Preoperative Stenting for Benign and Malignant Periampullary Diseases

Gholami, Sepideh; Brennan, Murray F.

doi:10.1016/j.suc.2017.09.005

Cited by 13 publications

(5 citation statements)

References 34 publications

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“…Thus, although there are no significant differences of severe morbidity, mortality, postoperative pancreatic fistula and infectious complications rates after PD in patients with percutaneous biliary drainage before PD compared with endoscopic stenting, however, procedure-related and overall post PD complications rates are significantly lower when percutaneous biliary drainage is performed (34). A recent review has shown that routine preoperative biliary drainage in patients submitted for PD should be avoided because it might be harmful, except in a subset of patients (debilitating pruritus, extensive preoperative work-up, signs of cholangitis or systemic infection with impaired renal function or other organ dysfunctions, neoadjuvant therapy, surgery not available in a reasonable period) (35).…”

Section: Discussionmentioning

confidence: 99%

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

Bartoș¹,

Ionescu²,

Iancu³

et al. 2018

chr

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National databases for pancreaticoduodenectomies (PD) have contributed to better postoperative outcomes after such complex surgical procedure because the multicentre collection of data allowed more reliable analyses with quality assessment and further improvement of technical issues and perioperative management. The current practice and outcomes after PD are poorly known in Romania because there was no national database for these patients. Thus, in 2016 a national-intent electronic registry for PD was proposed for all Romanian surgical centers. The study aims to present the preliminary results of this national-intent registry for PD after one-year enrollment. Patients The database was started on October 1st, 2016. Data were prospectively collected with an electronic online form including 102 items for each patient. The registry was opened to all the Departments of Surgery from Romania performing PD, with no restriction. During the first year of enrollment were collected the data of 181 patients with PD performed by 24 surgeons from four surgical centers. The age of patients was 64 years (28 - 81 years), with slightly male predominance (61.3%). Computed tomography was the main preoperative imaging investigation (84.5%). All the PDs were performed by an open approach. The Whipple technique was used in 53% of patients, and a venous resection was required in 14.3% of cases. A posterior approach PD was considered in 16.6% of patients. The stomach was used to treat the distal remnant pancreas in 50.1% of patients. The operative time was 285 min (110 - 615 min), and the estimated blood loss was 400 ml (80 - 3000 ml). The overall morbidity rate was 55.8%, with severe (i.e., grade III-IV Dindo-Clavien) morbidity rate of 10%, and 3.9% in-hospital mortality rate. The overall pancreatic fistula, delayed gastric emptying and hemorrhage rates were 19.9%, 39.8% and 15.5%. Periampullary malignancies were the main indications for PD (78.9%), with pancreatic cancer on the top (48%). To build a prospective electronic online database for PD in Romania appears to be a feasible project and a useful tool to know the current practice and outcomes after PD in our country. However, improvements are still required to encourage a larger number of surgical centers to introduce the data of patients with PD.

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Section: Discussionmentioning

confidence: 99%

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

Bartoș¹,

Ionescu²,

Iancu³

et al. 2018

chr

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“…Блохина на основании большого числа наблюдений показано, что количество осложнений ЧЧХС в 6 раз меньше, чем при открытых операциях, и в 1,5 раза меньше, чем при эндоскопическом желчеотведении. Однако малоинвазивные чрескожные операции, как и любые хирургические вмешательства, сопровождаются рядом осложнений, в том числе тяжелых [13]. Отсутствие единых взглядов на выбор оптимального мини-инвазивного подхода к осуществлению постоянного внутреннего желчеотведения при механической желтухе опухолевого генеза побудило нас проанализировать и выявить факторы риска развития нежелательных явлений, на основе которых была разработана и внедрена в клиническую практику программа для выбора оптимальной тактики лечения механической желтухи.…”

Section: оригинальные исследования введениеunclassified

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Васин¹,

Omelchenko

2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. The most pressing problems in abdominal oncology surgery are the development of obstructive jaundice as a complication in patients with malignant tumors in the hepatobiliary and pancreatoduodenal area, and the ways to eliminate it and to reduce the risk of adverse events. Our earlier research revealed 14 predictors that together are more likely to cause undesirable postoperative complications, including deaths during minimally invasive biliary tract decompression. On the basis of the data obtained, a computer program “Risk Assessment of Treatment Methods for Obstructive Jaundice” was created.Materials and methods. The program was introduced into clinical practice in Yaroslavl Regional Clinical Oncology Hospital and was tested on 144 patients from 2019 through 2022. Th e program issued a conclusion on the risk of adverse events and assigned the patient to one of the groups where drainage or stenting were recommended for the first stage of biliary tract decompression.Results and discussion. Following a collegial decision based on the results obtained via the program, 58 patients (40.28 %) underwent endoscopic stenting and 86 patients (59.72 %) underwent percutaneous transhepatic biliary drainage. In the study group, adverse events developed in 10 patients (6.94 %), while in the control group — in 50 patients (22.94 %), and 134 patients (93.06 %) had no complications, as compared to 168 patients (77.06 %) in the control group.Conclusion. Application of the program based on reliable and practically significant 14 predictors results in a decline in general complications induced by minimally invasive biliary tract decompression from 22.94 % to 6.94 % and a 3.5-fold decrease in mortality from 5.05 % to 1.39 % in patients with malignant neoplasms in the hepatobiliary and pancreatoduodenal area, complicated by obstructive and mixed jaundice.

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“…Die präoperative Stenteinlage führt nach Resektion zu einer höheren Rate infektiöser Komplikationen im Vergleich zu Patienten mit primärer Operation ohne Stent (74 % vs. 39 %) [ 21 , 22 ]. Diese Erkenntnisse treffen auch auf die Subgruppe von Patienten mit periampullären Pankreaskarzinomen zu, sodass auch bei diesen Patienten keine Empfehlung für ein routinemäßiges präoperatives Stenting ausgesprochen werden kann [ 23 ].…”

Section: Onkologische Resektion Und üBerlebenunclassified

Chirurgie periampullärer Pankreaskarzinome

Hank

Klaiber

Sahora

et al. 2021

Chirurg

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ZusammenfassungPeriampulläre Neoplasien sind eine heterogene Gruppe verschiedener Tumorentitäten der periampullären Region, von denen das Pankreasadenokarzinom mit 60–70 % am häufigsten ist. Wie typisch für Pankreaskarzinome zeichnen sich periampulläre Pankreaskarzinome durch ein aggressives Wachstum und eine frühe systemische Progression aus. Aufgrund ihrer besonderen Lage in unmittelbarer Nähe zur Papilla Vateri treten Symptome in eher früherem Tumorstadium auf, sodass die Therapiemöglichkeiten und Prognose insgesamt günstiger sind als bei Pankreaskarzinomen anderer Lokalisation. Trotzdem unterscheiden sich die Therapieprinzipien bei periampullären Pankreaskarzinomen nicht wesentlich von den Standards bei Pankreaskarzinomen anderer Lokalisation. Ein potenziell kurativer Therapieansatz beim nichtmetastasierten periampullären Pankreaskarzinom ist multimodal und besteht aus der Durchführung einer partiellen Duodenopankreatektomie als radikale onkologische Resektion in Kombination mit einer systemischen, meist adjuvant verabreichten Chemotherapie. Bei Patienten mit günstigen prognostischen Faktoren kann hierdurch ein Langzeitüberleben erzielt werden. Zudem wurden mit der Weiterentwicklung der Chirurgie und Systemtherapie auch potenziell kurative Therapiekonzepte für fortgeschrittene, früher irresektable Tumoren etabliert, welche nun nach Durchführung einer neoadjuvanten Therapie oft einer Resektion zugeführt werden können. In diesem Beitrag werden die aktuellen chirurgischen Prinzipien der radikalen onkologischen Resektion periampullärer Pankreaskarzinome im Kontext der multimodalen Therapie dargestellt und ein Ausblick auf mögliche künftige Entwicklungen der Therapie gegeben.

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Preoperative Stenting for Benign and Malignant Periampullary Diseases

Cited by 13 publications

References 34 publications

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Chirurgie periampullärer Pankreaskarzinome

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