Two Thousand Consecutive Pancreaticoduodenectomies

Cameron, John L.; He, Jin

doi:10.1016/j.jamcollsurg.2014.12.031

Cited by 503 publications

(370 citation statements)

References 7 publications

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“…Its centralization in specialized institutions has led to acceptable mortality rates below 5% (4,5). Highly standardized surgical techniques and perioperative care are required to achieve low morbidity and mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

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Section: Introductionmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…5 Surgery is feasible in 20% of patients, and following adjuvant chemotherapy may achieve a 5-year survival rate of 20%. 6 Following resection of periampullary cancer, 5-year survival may reach 20-50%. 7 As such, currently the best survival rates are achieved with resection, and adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…As operative techniques and peri-operative outcomes continue to improve, optimizing the eligibility criteria for resection is of great interest. 6,8 Furthermore, due to limited survival times, identifying those patients who do not benefit from a resection is equally important.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: A systematic review and meta-analysis

et al. 2016

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“…Conversion to open surgery was reported in 9.1% to 30.0% of cases, mostly due to venous invasion and intraoperative bleeding (7,44,46). Overall morbidity in LPD has been reported to range from 35-52%, however this difference was not found to be statistically significant between the surgical approaches (43,47,48).…”

Section: Pancreatoduodenectomy (Pd)mentioning

confidence: 99%