The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy

Kantor, Olga; Talamonti, Mark S.; Wang, Chi Hsiung; Roggin, Kevin K.; Bentrem, David J.; Winchester, David J.; Prinz, Richard A.; Baker, Marshall S.

doi:10.1016/j.hpb.2017.08.012

Cited by 18 publications

(13 citation statements)

References 33 publications

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“…As expected, both the operative time and blood loss were significantly higher when a venous resection was associated with PD (17). More recent data on larger number of patients have confirmed that increased morbidity and mortality rates should be expected when a venous resection is associated with PD (37). In the present cohort, a portal vein/ superior mesenteric vein resection was performed in 14.3% of PDs.…”

Section: Discussionsupporting

confidence: 59%

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: Discussionsupporting

confidence: 59%

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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“…Few reports of rate of vascular resection in a complete population exist to date. Two recent analyses from the US NSQIP database used a similar definition and methodology to the current study, and reported equal, 22 or lower, 29 rates of vascular resections.…”

Section: Hpbmentioning

confidence: 87%

The effect of centralization on short term outcomes of pancreatoduodenectomy in a universal health care system

Nymo

Søreide

Kleive

et al. 2019

HPB

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Background: Centralization of pancreatic resections is advocated due to a volume-outcome association. Pancreatic surgery is in Norway currently performed only in five teaching hospitals. The aim was to describe the short-term outcomes after pancreatoduodenectomy (PD) within the current organizational model and to assess for regional disparities.Methods: All patients who underwent PD in Norway between 2012 and 2016 were identified. Mortality (90 days) and relaparotomy (30 days) were assessed for predictors including demographic data and multi-visceral or vascular resection. Aggregated length-of-stay and national and regional incidences of the procedure were also analysed.Results: A total of 930 patients underwent PD during the study period. In-hospital mortality occurred in 20 patients (2%) and 34 patients (4%) died within 90 days. Male gender, age, multi-visceral resection and relaparotomy were independent predictors of 90-day mortality. Some 131 patients (14%) had a relaparotomy, with male gender and multi-visceral resection as independent predictors. There was no difference between regions in procedure incidence or 90-day mortality. There was a disparity within the regions in the use of vascular resection (p = 0.021). Conclusion:The short-term outcomes after PD in Norway are acceptable and the 90-day mortality rate is low. The outcomes may reflect centralization of pancreatic surgery.

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“…Chandrasegaram et al showed that the overall mortality associated with early SMV-PV thrombosis after pancreatectomy with or without grafts was 40% (8/20) compared to 11.1 % (3/27) in this systematic review after pancreatectomy with grafts [11,[13][14][15] . Kantor et al analyzed 640 patients undergoing pancreatoduodenectomy with venous resection in the American College of Surgeons National Surgical Quality Improvement Project from 2006 to 2013 [16] . Of these 224 patients had a graft repair that was associated with increased overall morbidity (58.7 %, p<0.01) and 30-day mortality rates (21 of 229, 7.7 %, p<0.01) [16] .…”

Section: Discussionmentioning

confidence: 99%

Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery – A systematic review

Labori

Kleive

Khan

et al. 2021

HPB

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The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy

Abstract: The risk of significant morbidity and mortality for PDVR is associated with the extent of vascular resection, with graft repairs having increased morbidity and mortality rates.

Cited by 18 publications

References 33 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

The effect of centralization on short term outcomes of pancreatoduodenectomy in a universal health care system

Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery – A systematic review

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