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Gajda M, Grudzińska E, Szmigiel P, Czopek P, Rusinowski C, Putowski Z, Mrowiec S. Risk Factors of Postoperative Acute Pancreatitis and Its Impact on the Postoperative Course after Pancreaticoduodenectomy-10 Years of Single-Center Experience. Life (Basel) 2023; 13:2344. [PMID: 38137945 PMCID: PMC10744948 DOI: 10.3390/life13122344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Clinically relevant acute postoperative pancreatitis (CR-PPAP) after pancreaticoduodenectomy (PD) is a complication that may lead to the development of local and systemic consequences. The study aimed to identify risk factors for CR-PPAP and assess the impact of CR-PPAP on the postoperative course after PD. METHODS The study retrospectively analyzed data from 428 consecutive patients who underwent PD at a single center between January 2013 and December 2022. The presence of increased amylase activity in plasma, above the upper limit of normal 48 h after surgery, was checked. CR-PPAP was diagnosed when accompanied by disturbing radiological features and/or symptoms requiring treatment. We investigated the relationship between the occurrence of CR-PPAP and the development of postoperative complications after PD, and possible predictors of CR-PPAP. RESULTS The postoperative follow-up period was 90 days. Of the 428 patients, 18.2% (n = 78) had CR-PPAP. It was associated with increased rates of CR-POPF, delayed gastric emptying, occurrence of intra-abdominal collections, postoperative hemorrhage, peritonitis, and septic shock. Patients who developed CR-PPAP were more often reoperated (37.17% vs. 6.9%, p < 0.0001)) and had increased postoperative mortality (14.1% vs. 5.74%, p < 0.0001). Soft pancreatic parenchyma, intraoperative blood loss, small diameter of the pancreatic duct, and diagnosis of adenocarcinoma papillae Vateri were independent risk factors for CR-PPAP and showed the best performance in predicting CR-PPAP. CONCLUSIONS CR-PPAP is associated with an increased incidence of postoperative complications after PD, worse treatment outcomes, and an increased risk of reoperation and mortality. Pancreatic consistency, intraoperative blood loss, width of the duct of Wirsung, and histopathological diagnosis can be used to assess the risk of CR-PPAP. Amylase activity 48 h after surgery > 161 U/L is highly specific in the diagnosis of CR-PPAP.
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Affiliation(s)
- Magdalena Gajda
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (M.G.)
| | - Ewa Grudzińska
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (M.G.)
| | - Paweł Szmigiel
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (M.G.)
| | - Piotr Czopek
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (M.G.)
| | - Cezary Rusinowski
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (M.G.)
| | - Zbigniew Putowski
- Center for Intensive and Perioperative Care, Jagiellonian University, 31-007 Cracow, Poland
| | - Sławomir Mrowiec
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (M.G.)
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Fancellu A, Maiore M, Grasso L, Ferrara M, Porcu A. Retroaortic left renal vein associated to variations of liver vasculature and biliary system in a patient submitted to total pancreatectomy. Hepatobiliary Pancreat Dis Int 2023:S1499-3872(23)00206-0. [PMID: 37968191 DOI: 10.1016/j.hbpd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy.
| | - Mario Maiore
- Department of Medicine, Surgery and Pharmacy, Unit of Radiology, University of Sassari, Sassari 07100, Italy
| | - Lavinia Grasso
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Miriam Ferrara
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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Stoop TF, von Gohren A, Engstrand J, Sparrelid E, Gilg S, Del Chiaro M, Ghorbani P. Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management. Ann Surg Oncol 2023; 30:7700-7711. [PMID: 37596448 PMCID: PMC10562271 DOI: 10.1245/s10434-023-13847-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/19/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP. METHODS This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC. RESULTS The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%; p = 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%; p = 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142-4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175-0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034-4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772-24.362). CONCLUSIONS After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.
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Affiliation(s)
- Thomas F Stoop
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - André von Gohren
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Gilg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
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Pieralice S, Coppola A, Maddaloni E. Updates on Glycaemic Control Strategies: A Range of Opportunities after Total Pancreatectomy. J Clin Med 2023; 12:jcm12093306. [PMID: 37176746 PMCID: PMC10179154 DOI: 10.3390/jcm12093306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
In the past, indications for total pancreatectomy (TP) were rare, with several concerns about patients' postoperative quality of life due to exocrine and endocrine post-pancreatectomy management [...].
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Affiliation(s)
- Silvia Pieralice
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | | | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Olakowski M, Grudzińska E. Pancreatic head cancer - Current surgery techniques. Asian J Surg 2023; 46:73-81. [PMID: 35680512 DOI: 10.1016/j.asjsur.2022.05.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/30/2022] [Accepted: 05/20/2022] [Indexed: 12/24/2022] Open
Abstract
Pancreatic head cancer is a highly fatal disease. For now, surgery offers the only potential long-term cure albeit with a high risk of complications. However, the progress of surgical technique during the past decade has resulted in 5-year survival approaching 30% after resection and adjuvant chemotherapy. This paper presents current data on the recommended extent of lymphadenectomy, the resection margin, on the definition of resectable and borderline resectable tumors and mesopancreas. Surgical techniques proposed to improve PD are presented: the artery first approach, the uncinate process first, the mesopancreas first approach, the triangle operation, periarterial divestment, and multiorgan resection.
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Affiliation(s)
- Marek Olakowski
- Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland
| | - Ewa Grudzińska
- Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland.
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Synchronous Pancreatic Ductal Adenocarcinoma in the Head and Tail, a Double Trouble: A Case Report and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12112709. [PMID: 36359552 PMCID: PMC9689396 DOI: 10.3390/diagnostics12112709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Synchronous primary pancreatic ductal adenocarcinoma (PDAC) is very rare and can be formed either through multicentric carcinogenesis or intrapancreatic metastasis. We report the case of an 80-year-old man with a history of type 2 diabetes mellitus who presented with abdominal pain and weight loss. Laboratory tests showed elevated levels of blood glucose and CA 19-9, and Computed Tomography revealed two hypoenhancing lesions in the head and tail of the pancreas. Endoscopic ultrasound, which is the imaging method of choice for pancreatic cancer, was performed with a fine needle biopsy, and the cytological analysis diagnosed PDAC in both lesions. The patient underwent total pancreatectomy, and pathologic evaluation revealed synchronous primary PDAC with moderate to poor differentiation in the head and tail in the setting of IPMN (intraductal papillary mucinous neoplasia) and chronic pancreatitis. After his recovery from postoperative pulmonary embolism, the patient was discharged home with sufficient glycemic control. Multifocal PDAC occurs more often when precursor lesions, such as IPMN, pre-exist. The optimal treatment for multiple lesions spread all over the pancreas is total pancreatectomy. Diabetes mellitus is a serious complication of total pancreatectomy (new-onset or type 3c), but overall, long-term survival has been significantly improved.
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Falconi M. Total pancreatectomy: how, when and why? Updates Surg 2021; 73:1203-1204. [PMID: 34286418 DOI: 10.1007/s13304-021-01134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Massimo Falconi
- School of Medicine, Vita Salute San Raffaele University, Milan, Italy.
- Division of Pancreatic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy.
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