The influence of fellowship training on the practice of pancreatoduodenectomy

Kennedy, Gregory T.; McMillan, Matthew T.; Sprys, Michael H.; Bassi, Claudio; Greig, Paul D.; Hansen, Paul; Jeyarajah, D. Rohan; Kent, Tara S.; Malleo, Giuseppe; Marchegiani, Giovanni; Minter, Rebecca M.; Vollmer, Charles M.

doi:10.1016/j.hpb.2016.09.008

Cited by 13 publications

(7 citation statements)

References 38 publications

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“…This study has an additional peculiarity: while previous reports analysing the impact of PAP on post‐operative outcomes focused on patients undergoing a PJ as pancreatoenteric continuity restoration modality in the majority of cases, all 102 patients analysed here underwent a PG using a binding technique. An international survey published in 2016 has reported PJ as the preferred anastomotic method used worldwide; 22 however, PG is increasingly used due to supposed advantages compared to PJ: results from previous randomized clinical trials and meta‐analyses comparing PG and PJ, even if contrasting in some cases, seem to indicate that PG is associated with lower rates of POPF and higher rates of PPH, 22,23 and our results are consistent with such data.…”

Section: Discussionsupporting

confidence: 89%

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Zimmitti

Langella²,

Sega

et al. 2020

ANZ Journal of Surgery

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Background Recent reports suggest that, following pancreatic resection, serum amylase elevation (SAE) may be a surrogate indicator of post‐operative acute pancreatitis (PAP) and predict post‐operative pancreatic fistula (POPF). However, POPF may not account for the majority of complications when pancreatoenteric continuity is restored by pancreatogastrostomy. We aimed to evaluate, among patients undergoing pancreatoduodenectomy with pancreatogastrostomy, the correlation between SAE, radiological changes consistent with PAP and types of post‐operative complications overall and specific for pancreatic surgery. Methods Perioperative data from 102 patients who underwent pancreatoduodenectomy with pancreatogastrostomy at two Italian hospitals (January 2015–January 2017) were retrospectively analysed. SAE was defined as serum amylase more than three times the normal concentration at post‐operative day 1. Post‐operative abdominal computed tomography scan was routinely performed and retrospectively and blindly re‐assessed for findings consistent with PAP. Results Among 102 study patients, overall and major complications and mortality occurred in 68% and 24% and 3% of cases, respectively. POPF and post‐pancreatectomy haemorrhage (PPH) occurred in 12% and 21%, respectively. In 75% of patients developing PPH, it occurred in the absence of POPF. SAE occurred in 36 patients who, compared to 66 non‐SAE patients, more frequently showed computed tomography scan findings consistent with pancreatic stump inflammation (P = 0.002), confirming association between SAE and PAP. SAE was independently associated with the occurrence of major complications, POPF and PPH (hazard ratio (HR) 3.27, P = 0.032; HR 3.94, P = 0.012; HR 12.26, P = 0.002). Conclusion SAE can be considered a valid surrogate of PAP and is strongly associated with a higher rate of post‐operative major complications, both overall and specific for pancreatic resection.

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Section: Discussionsupporting

confidence: 89%

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Zimmitti

Langella²,

Sega

et al. 2020

ANZ Journal of Surgery

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“…The modality of pancreato-enteric continuity restoration following PD represents one of the greatest controversies in pancreatic surgery. PJ has been reported as the preferred anastomotic method in an international survey recently published [16] and IJL-PJ, first described in 1978, has been associated with some benefits, related to the diversion of biliary secretions from the pancreatic anastomosis, which may avoid activation of pancreatic proenzymes and, thereby, theoretically protect the anastomotic healing [17][18][19][20]. However, previous studies comparing PG and PJ seem favoring PG in terms of rate of POPF [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Outcomes comparison of Pancreato-Gastrostomy and Isolated Jejunal Loop Pancreato-Jejunostomy following Pancreato-Duodenectomy in patients with soft pancreas and at moderate-high risk for POPF: a retrospective multicenter experience-based analysis

et al. 2021

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Following pancreatoduodenectomy (PD), the modality of pancreato-enteric continuity restoration may impact on postoperative pancreatic fistula (POPF) risk. The aim of this study is to compare, among patients with soft pancreas and at moderate/high risk for POPF, the outcomes of PD with Pancreato-Gastrostomy (PG), versus Isolated Jejunal Loop Pancreato-Jejunostomy (IJL-PJ). 193 patients with a Callery Fistula Risk Score (C-FRS) ≥ 3 operated at 3 HPB Units, two performing PG and one IJL-PJ as their preferred anastomotic technique following PD (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) were included in this study (PG = 123, IJL-PJ = 70). Primary outcomes were POPF, clinically relevant (cr-)postoperative pancreatic hemorrhage (cr-PPH), delayed gastric emptying (cr-DGE), and postoperative major complications and mortality. POPF, cr-PPH, and cr-DGE occurred in 21.8%, 17.6%, and 11.4% of patients, and did not differ significantly between PG (26%, 19.5%, and 10.6%, respectively) and IJL-PJ (17.1%, 14.3%, and 12.9%, respectively; all p > 0.05) patients. Major (Dindo ≥ 3) complication and mortality rates were 26.4% and 3.3%, respectively, and did not differ significantly between PG (29.3% and 3.8%) and IJL-PJ (21.4% and 2.9) patients (p > 0.05). A faster surgical drain and nasogastric tube removal matched a significantly shorter hospitalization among IJL-PJ patients (median LOS: 18 days versus 25 days among PG patients, p < 0.001). In conclusion, IJL-PJ and PG, when performed by surgeons specialized with the concerned anastomotic technique in patients with soft pancreas and moderate/high risk for POPF, have similar results in terms of perioperative mortality and postoperative complications both overall and specific for PD.

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“…Not only the number of surgeries, but also the surgeon's experience and age may influence the result with sometimes even an increased mortality and morbidity risk in very experienced surgeons who have been working in their discipline for more than 20 years [190][191][192]. Some studies reveal a benefit of specialization with regard to the outcome [187,[193][194][195]. It seems reasonable to consider other factors such as the quality of surgical performance and adjuvant therapies, that might influence the outcome, as well [196,197].…”

Section: Surgical Training/surgeon-specific Factorsmentioning

confidence: 99%

Qualität in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen

Hildenbrand

Ketterer

2020

Laryngo-Rhino-Otol

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Hildenbrand T et al. Qualität in der chirurgischen … Laryngo-Rhino-Otol 2020; 99: S5-S33 ZusaMMenfassung Die endonasale endoskopische Nasennebenhöhlenchirurgie hat sich als Standard der operativen Therapie bei chronisch entzündlichen Erkrankungen der Nasennebenhöhlen etabliert. Eine Verbesserung der subjektiven Beschwerden und objektiven Befunde konnte in zahlreichen Studien nachgewiesen werden. Aufgrund der häufig beobachteten Diskrepanz zwischen objektiven und subjektiven Ergebnissen nach Nasennebenhöhlenchirurgie kommt der Messung des sog. patient reported outcome eine zunehmende Bedeutung zu. Qualität und Effizienz in der Medizin haben in den letzten Jahren zunehmend an Bedeutung gewonnen. In vielen Ländern und auch länderübergreifend wurden bereits durch Zusammenschluss von Experten, z.T unter Federführung verschiedener Fachgesellschaften, Initiativen zur Verbesserung der Qualität in der chirurgischen Versorgung gegründet.Die vorliegende Arbeit stellt eine Übersicht qualitätsrelevanter Faktoren in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen anhand der vorhandenen Literatur, v.a. der Prozess-und Ergebnisqualität, dar. Ein besonderes Augenmerk liegt auf der subjektiven Bewertung der Ergebnisqualität durch den Patienten.absTraCT Endonasal endoscopic surgery of the paranasal sinuses is the gold standard in surgical treatment of chronic inflammatory diseases of the paranasal sinuses. Improvement of subjective complaints and objective findings has been confirmed in numerous studies. Due to the discrepancy between objective and subjective results after paranasal sinus surgery, the assessment of patient reported outcomes has gained importance.Quality and efficiency in medicine became increasingly important during the last years. In many countries and transnationally, the association of experts, partly coordinated by different medical societies, led to initiatives focusing on improvement of the quality of surgical care. The present article represents an overview of quality-related factors in surgical treatment of chronic inflammatory diseases of the paranasal sinuses, summarizing the existing literature and focusing particularly on process and outcomes quality. Particular attention will be paid to the outcome quality individually assessed by the patients. S5Online publiziert: 16.03.2020 Hildenbrand T et al. Qualität in der chirurgischen … Laryngo-Rhino-Otol 2020; 99: S5-S33 Referat < 200 200 -400 Anzahl der Operationen Anzahl der Kliniken in % > 400 57,6 % 38,3 % 36,4 % 12,8 % städtisch/kirchlich/privat Uniklinik Krankenhaus S7 Hildenbrand T et al. Qualität in der chirurgischen … Laryngo-Rhino-Otol 2020; 99: S5-S33 Referat ren < 20 Operationen pro Jahr durch. Zwischen 20 und 50 Operationen werden von 38,4 % der Kliniken durchgeführt und mehr als 50 Operationen geben lediglich 2 % der Kliniken an (▶abb. 2). 83,1 % aller Kliniken gaben an, an einem interdisziplinären Tumorboard teilzunehmen und 68,4 % führen interdisziplinäre Tumoroperationen bei Erkrankungen der Nasennebenhöhle...

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The influence of fellowship training on the practice of pancreatoduodenectomy

Abstract: Fellowship training correlated with significant differences in surgeon experience, operative approach, and use of available fistula mitigation strategies for PD.

Cited by 13 publications

References 38 publications

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Outcomes comparison of Pancreato-Gastrostomy and Isolated Jejunal Loop Pancreato-Jejunostomy following Pancreato-Duodenectomy in patients with soft pancreas and at moderate-high risk for POPF: a retrospective multicenter experience-based analysis

Qualität in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen

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