What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study

Lee, Kit‐Fai; Wong, Kandy Kam Cheung; Lo, Edward C M; Kung, Janet W.C.; Lok, Hon‐Ting; Chong, Charing Ching Ning; Wong, John; Lai, Paul B.S.; Ng, Kkc

doi:10.14701/ahbps.21-054

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…In this series, there was no operative mortality, but the morbidity was 87.5% and the POPF rate was 37.5%. During a similar period in our institution, the mortality, morbidity and POPF rate of elective PD were 1.7%, 51.4%, and 10.1%, respectively [15]. No doubt PD carried a higher risk in an emergency setting despite HBP surgeons being involved in all the cases in this series.…”

Section: Discussionsupporting

confidence: 56%

“…This could add much more stress to the operating surgeons with the operation done at odd hours and unexpectedly. The median blood loss of 1,825 mL and length of hospital stay of 23.5 days were also compared unfavorably with elective cases (mean blood loss 740 mL, hospital stay 18.3 days) [15]. Nevertheless, EPD was meant for life-saving and in this sense, it was regarded as successful given that there was no operative mortality and all except three patients survived till now without longterm complications.…”

Section: Discussionmentioning

confidence: 99%

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A case series of emergency pancreaticoduodenectomies: What were their indications and outcomes?

Lee,

Kung,

Fung

et al. 2023

Ann Hepatobiliary Pancreat Surg

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Emergency pancreaticoduodenectomy (EPD) is a rarely performed operation. It is important to know the indications and outcomes of EPD to have a better understanding of its application in clinical practice. A review of eight consecutive cases of EPD was done. Between January 2003 and December 2021, 8 out of 370 patients (2.2%) in a single center received pancreaticoduodenectomy as emergency. There were six males and two females with a median age of 45.5 years. The indications were trauma in three patients, bleeding tumors in two patients, and one patient each in obstructing duodenal tumor, postoperative complication and post-endoscopic retrograde cholangiopancreatography (ERCP) complication. The median operative time and blood loss were 427.5 minutes and 1,825 mL, respectively. There was no operative mortality. Seven patients (87.5%) had postoperative complications. Three patients (37.5%) developed postoperative grade B pancreatic fistula. The median postoperative hospital stay was 23.5 days. Five patients were still alive while three patients survived for 13, 31, and 42 months after the operation. The causes of death were recurrent tumors in two patients, and sepsis in one patient. According to this case series, EPD is associated with increased morbidity and pancreatic fistula, but is still deserved in life-threatening situations and long-term survival is possible after EPD.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

A case series of emergency pancreaticoduodenectomies: What were their indications and outcomes?

Lee,

Kung,

Fung

et al. 2023

Ann Hepatobiliary Pancreat Surg

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“…PD was performed either as a standard Whipple operation or as pylorus preserving type. The operative technique has been described previously [13]. Standard but not extended lymphadenectomy was carried out for all cases.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Involved Resection Margin on Recurrence and Survival After Pancreaticoduodenectomy for Periampullary Carcinoma, with Emphasis on Pancreatic Head Carcinoma

Lee

Lok²,

Fung³

et al. 2022

World j. surg.

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Background The supposed adverse effect of involved resection margin during pancreaticoduodenectomy (PD) for periampullary carcinoma or pancreatic head carcinoma (CaP) on long‐term oncological outcomes is still inconclusive. Methods This is a retrospective study on periampullary carcinoma undergoing PD. Patients with R0 (margin clear) resection were compared to patients with R1 (microscopically directly involved margin) resection. Patients with gross involved margin (R2 resection) were excluded. Long‐term oncological outcomes measured included incidence and site of recurrent disease, overall survival (OS) and disease‐free survival (DFS). A subgroup analysis was made on patients with CaP. Results Between January 2003 and December 2019, 203 PD were identified for present study. The incidence of R1 resection was common (12% in periampullary carcinoma and 20% in CaP). In periampullary carcinoma, R1 resection had greater proportion of CaP, lesser proportion of carcinoma of ampulla (CaA), more perineural invasion, more lymph node (LN) metastasis. R1 group had a shorter OS and DFS, but no difference in the incidence and site of recurrent disease. In the subgroup of CaP (91 patients), R1 group did not differ from R0 group except for more LN metastasis. There was no difference in incidence and site of recurrent disease, OS and DFS. On multivariable analysis, R1 resection was not an independent factor for OS and DFS for periampullary carcinoma or for CaP only. Conclusion Involved resection margin was not uncommon. It was not associated with higher incidence of recurrent disease including local recurrence, and was not an independent prognosticator for OS and DFS.

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Challenges during pancreatoduodenectomy and ways to overcome them

Akhmetzyanov,

Kotelnikov,

Ter-Ovanesov

et al. 2024

Sib. onkol. ž.

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Background. Pancreaticoduodenal resection (PDR) is the surgical procedure for cancer of the head of the pancreas, distal common bile duct, duodenum and ampulla of Vater. This surgery is associated with a high risk of complications, the development of which can be influenced by various factors. since pancreatic fistula is a key complication of PDR, the choice of the method for pancreatic anastomosis becomes especially important. Material and methods. The search for publications was carried out using the PubMed and Elibrary systems from January 1980 to January 2024. of the 2,300 sources found, 69 were used to write the review. We included data from both retrospective and prospective clinical trials that were devoted to pancreatoduodenectomy for malignant neoplasms, the difficulties encountered in performing this surgery and ways to solve them. Results. Currently, there are more than 60 types of pancreatico-digestive anastomosis, which indirectly indicates the absence of a universal one that ensures the prevention of pancreatic fistula. The treatment outcomes may be influenced by the nature of neoadjuvant treatment, concomitant diseases, anatomical features, presence of obstructive jaundice and methods of its relief. The main mechanisms of influence of negative factors on the development of complications are considered. an individual approach to the patient, taking into account all factors, can significantly reduce the risk of complications.

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What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study

Cited by 3 publications

References 31 publications

A case series of emergency pancreaticoduodenectomies: What were their indications and outcomes?

A case series of emergency pancreaticoduodenectomies: What were their indications and outcomes?

The Impact of Involved Resection Margin on Recurrence and Survival After Pancreaticoduodenectomy for Periampullary Carcinoma, with Emphasis on Pancreatic Head Carcinoma

Challenges during pancreatoduodenectomy and ways to overcome them

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