The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy: A network meta-analysis of randomized control trials

Wang, Weidong; Zhang, Zhaohui; Gu, Chichang; Liu, Qingbo; Zhiqiang, Liang; He, Wei; Chen, Jianping; Lai, Jiaming

doi:10.1016/j.ijsu.2018.04.005

Cited by 42 publications

(30 citation statements)

References 31 publications

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“…The incidence of pancreatic leak is decreasing with experience and attention to technical details such as a wide duct to mucosa anastomosis and the dunking effect of the Blumgart stitches, which was the anastomotic technique used in this patient. However, until now, no differences have been found in several metaanalyses in the postoperative pancreatic fistulas related to the comparison of different techniques of pancreaticojejunostomy [17].…”

Section: Discussionmentioning

confidence: 98%

Pancreas- and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis

Leite

Tralhão

Manso

et al. 2019

GE Port J Gastroenterol

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Most patients with familial adenomatous polyposis (FAP) will develop duodenal polyps and 5% progress to cancer. Those with Spigelman stage IV have a 36% risk of cancer at 10 years. Endoscopic surveillance is necessary with local ablation for early disease. Unresectable duodenal disease and severe dysplasia are an indication for prophylactic radical surgery by pancreaticoduodenectomy or pancreas-sparing duodenectomy. Some preliminary results have shown better outcomes with duodenectomy. A 45-year-old female with FAP had restorative proctocolectomy at 24 years, desmoid of the mesentery with regression after sulindac, two pregnancies, and at the age of 37 years had duodenal polyposis stage III carpeting the periampullary region. Endoscopic papillectomy and extensive piecemeal mucosectomy was performed but was unsuccessful due to recurrence. After 7 years of regular endoscopic surveillance, focal high-grade dysplasia was diagnosed at the last evaluation. Some dimin-utive polyps were seen in the small-bowel capsule endoscopy. MRCP showed a normal biliary and pancreatic duct without visualization of the Santorini duct. A pancreas and pylorus-preserving duodenectomy was performed with 3 main steps: (1) duodenectomy with preservation of the pancreas and the pylorus; (2) reconstruction with an advanced jejunal limb and duodenojejunostomy; (3) reimplantation of the biliary and pancreatic duct in the jejunal loop. The patient was discharged on the 11th postoperative day without complications. In conclusion, pancreas-and pylorus-preserving duodenectomy is a promising alternative to pancreaticoduodenectomy for advanced duodenal polyposis that allows complete endoscopic surveillance.

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Section: Discussionmentioning

confidence: 98%

Pancreas- and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis

Leite

Tralhão

Manso

et al. 2019

GE Port J Gastroenterol

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“…The ways to reduce the incidences of postoperative complications after PD are still being sought. Careful surgical techniques, with the choice of the optimal reconstruction method, is most crucial to improve postoperative outcomes [3]. However, nutritional support in patients undergoing PD is also very important, because a significant number of these patients are malnourished due to the basic disease.…”

Section: Introductionmentioning

confidence: 99%

The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

Jabłońska

Mrowiec

2020

Nutrients

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Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgical procedures in abdominal surgery. Malnutrition and immune dysfunction in patients with pancreatic cancer (PC) may lead to a higher risk of postoperative infectious complications. Although immunonutrition (IN) is recommended for enhanced recovery after surgery (ERAS) in patients undergoing PD for 5–7 days perioperatively, its role in patients undergoing pancreatectomy is still unclear and controversial. It is known that the proper surgical technique is very important in order to reduce a risk of postoperative complications, such as a pancreatic fistula, and to improve disease-free survival in patients following PD. However, it has been proven that IN decreases the risk of infectious complications, and shortens hospital stays in patients undergoing PD. This is a result of the impact on altered inflammatory responses in patients with cancer. Both enteral and parenteral, as well as preoperative and postoperative IN, using various nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides, is administered. The most frequently used preoperative oral supplementation is recommended. The aim of this paper is to present the indications and benefits of IN in patients undergoing PD.

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“…Several different approaches have been used in efforts to mitigate the impact of POPFs, like different variants of pancreatic anastomosis [4][5][6], the use of fibrin and acrylic glues [7,8] of the hormone somatostatin, or its synthetic analogs (SA) [9,10] of internal or external stents [2,[11][12][13]. Placing drains during pancreatic surgery is a common strategy for preventing fluid accumulations and their infection, to mitigate POPF-related complications and to facilitate the detection of other intra-abdominal complications, including hemorrhage [14,15].…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

Pedrazzoli

Brazzale

2020

Langenbecks Arch Surg

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Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.

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The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy: A network meta-analysis of randomized control trials

Cited by 42 publications

References 31 publications

Pancreas- and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis

Pancreas- and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis

The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy

Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

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