Surgical Therapy for Pancreatic and Periampullary Cancer

Ammori, John B.; Choong, Kevin K. L.; Hardacre, Jeffrey M.

doi:10.1016/j.suc.2016.07.001

Cited by 14 publications

(12 citation statements)

References 88 publications

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“…[4,13,15,29] It was demonstrated that there was no difference between standard PD and pylorus-preserving pancreaticoduodenectomy in survival in a previous study. [27] With the improvements of surgical techniques and progresses in peri- and postoperative care, the postoperative mortality rate in patients who underwent PD for PACs has decreased to less than 5%, [30] which was consistent with our results (4.8%). Patient selection was reported as a vital factor in decreasing postoperative morbidity and mortality.…”

Section: Discussionsupporting

confidence: 89%

“…Surgical resection is the only and most effective curative treatment for PACs. [5,27] Among of them, PD as a radical resection is the standard treatment for patients with resectable PACs. [12,15,28] In our study, the 5-year survival rate of resected PACs was 41.3%, which was consistent with the results reported by previous studies (15%–65%).…”

Section: Discussionmentioning

confidence: 99%

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Influence of non-jaundice stage at diagnosis on clinicopathological features and long-term survival of patients with periampullary carcinomas

et al. 2019

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The effect of non-jaundice stage at diagnosis on clinicopathological features and prognosis of patients with periampullary carcinomas (PACs) remains uncertain.The 504 patients who were pathologically diagnosed with PACs between 2012 and 2017 were retrospective analyzed. Kaplan–Meier method was used to estimate survival and log-rank tests were used for comparisons between groups.Patients were divided into the non-jaundice group and the jaundice group according to serum total bilirubin (3 mg/dL) at diagnosis. By comparison with the jaundice group, more patients of the non-jaundice group manifested abdominal pain with longer duration. The degree of deterioration of complete blood count, liver function and CA19-9 in the non-jaundice group was significantly lower (P < .001). The non-jaundice group had larger tumor size (P = .001), more duodenal carcinoma and pancreatic carcinoma (P < .001), lower resection rate (P = .001) and less pancreatic and perineural invasion (P = .017, P = .002). The I stage was significantly more common in the non-jaundice group (P < .001). The cumulative 5-year survival of the non-jaundice group was significantly higher (P = .032). Multivariate analysis for all patients demonstrated that CEA level, cell differentiation, chemotherapy, and recurrence were independent prognostic factors.Patients with PACs in a non-jaundice stage at diagnosis showed more favorable clinicopathological features and long-term survival than such patients with jaundice.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Influence of non-jaundice stage at diagnosis on clinicopathological features and long-term survival of patients with periampullary carcinomas

et al. 2019

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“…PD is a complex abdominal surgery associated with high morbidity. 2 Preoperative optimization of patients undergoing PD is very important. 21 One of the problems encountered in such patients is obstructive jaundice and malnutrition.…”

Section: Discussionmentioning

confidence: 99%

“… 1 The standard treatment for periampullary tumor is pancreaticoduodenectomy (PD), which is a complex surgery with high morbidity. 2 Recently, there have been a number of studies reporting the poor outcomes of patients with severe jaundice who had underwent PD. 3 , 4 The pathophysiology of a poor surgical outcome in obstructive jaundice includes the following: blockage of bile salts in the intestinal tract induces the proliferation of the normal microbial flora, dysfunction of the intestinal mucosal barrier, bacterial translocation, increasing endotoxin concentrations in the portal circulation, altered Kupffer cell function affecting the liver’s reticuloendothelial system, decreased cellular immunity, and prolonged wound healing.…”

Section: Introductionmentioning

confidence: 99%

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

et al. 2021

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Objective: The objective of this study was to examine the relationship between the rate of bilirubin decrease following preoperative biliary drainage before pancreaticoduodenectomy and postoperative morbidity. Methods: Records of patients who underwent pancreaticoduodenectomy at the Department of Surgery in Ramathibodi Hospital between January 2008 and December 2019 were retrospectively reviewed. The patients were classified into either an adequate or inadequate drainage rate groups according to the bilirubin decrease rate. Major morbidity was defined as higher than grade II in the Clavien-Dindo classification. Risk factors for major morbidity were analyzed by logistic regression analysis. Results: In total, 166 patients were included in the study. Major morbidity was observed in 36 patients (21.6%). Adequate biliary drainage rate was observed in 39 patients (23.4%). Patients who had major morbidity were less likely to have come from the adequate biliary drainage rate group than the inadequate group (38.9% vs. 61.1%). However, through multivariate logistic analysis, only body mass index, operative time, and pancreatic duct diameter were independent factors associated with major morbidity, whereas the bilirubin decrease rate was not. Conclusions: Bilirubin decrease rate following preoperative biliary drainage has no significant association with major postoperative morbidity after pancreaticoduodenectomy.

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“…The standard treatment for periampullary tumor is pancreaticoduodenectomy (PD)[1]. PD is a complex surgical procedure with a high morbidity rate of up to 50%[2-4].…”

Section: Introductionmentioning

confidence: 99%

Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy

Rungsakulkij

Tangtawee

Suragul

et al. 2019

WJCC

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BACKGROUNDPancreaticoduodenectomy (PD) is a complex surgical procedure with a high morbidity rate. The serious complications are major risk factors for poor long-term surgical outcome. Studies have reported an association between early postoperative prognostic nutritional index (PNI) and prediction of severe complications after abdominal surgery. However, there have been no studies on the use of early postoperative PNI for predicting serious complications following PD.AIMTo analyze the risk factors and early postoperative PNI for predicting severe complications following PD.METHODSWe retrospectively analyzed 238 patients who underwent PD at our hospital between January 2007 and December 2017. The postoperative complications were classified according to the Dindo-Clavien classification. Grade III-V postoperative complications were classified as serious. The risk factors for serious complications were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTSOverall complications were detected in 157 of 238 patients (65.9%) who underwent PD. The grade III-V complication rate was 26.47% (63/238 patients). The mortality rate was 3.7% (9/238 patients). Multivariate logistic regression analysis revealed that preoperative serum albumin [odds ratio (OR): 0.883, 95% confidence interval (CI): 0.80-0.96; P < 0.01] and PNI on postoperative day 3 < 40.5 (OR: 2.77, 95%CI: 1.21-6.38, P < 0.05) were independent factors associated with grade III-V postoperative complications.CONCLUSIONPerioperative albumin is an important factor associated with serious complications following PD. Low early postoperative PNI (< 40.5) is a predictor for serious complications.

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Surgical Therapy for Pancreatic and Periampullary Cancer

Cited by 14 publications

References 88 publications

Influence of non-jaundice stage at diagnosis on clinicopathological features and long-term survival of patients with periampullary carcinomas

Influence of non-jaundice stage at diagnosis on clinicopathological features and long-term survival of patients with periampullary carcinomas

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy

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