Pancreatic Fistula and Delayed Gastric Emptying Are the Highest-Impact Complications After Whipple

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy. Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that the major complication and reoperation rates following isolated pancreaticojejunostomy were lower than with conventional pancreaticojejunostomy (OR=0.35, 95% CI: 0.13–0.96, P=0.04 and OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage , reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy. Conclusions This study showed that isolated pancreaticojejunostomy was associated with fewer major complications and a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

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Delayed gastric emptying after pancreatoduodenectomy: comparison between two different pancreatic reconstruction techniques

10.21203/rs.2.10531/v1 ◽

2019 ◽

Author(s):

Satoshi Hayama ◽

N Senmaru ◽

Satoshi Hirano

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Frequent Occurrence ◽

Reconstruction Technique ◽

Similar Frequency ◽

Abdominal Complications ◽

Factors Associated ◽

Pancreatic Reconstruction

Abstract Background The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Methods A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction. Results The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups. Conclusions Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

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Neoadjuvant Therapy Decreases Postoperative Pancreatic Fistula, Delayed Gastric Emptying, and Systemic Morbidity in Patients Undergoing Pancreaticoduodenectomy: An American College of Surgeons NSQIP Analysis

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.529 ◽

2020 ◽

Vol 231 (4) ◽

pp. S164

Author(s):

Alexa Glencer ◽

Jeremy Sharib ◽

Paige Bracci ◽

Tyler J. York ◽

Sophia Hernandez ◽

...

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Neoadjuvant Therapy ◽

Delayed Gastric Emptying ◽

Postoperative Pancreatic Fistula ◽

American College Of Surgeons

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A technique for decreasing delayed gastric emptying in the setting of pancreatic fistula

HPB ◽

10.1016/j.hpb.2018.06.1854 ◽

2018 ◽

Vol 20 ◽

pp. S841-S842

Author(s):

B.A. Sayed ◽

C.A. Moulton ◽

P. Greig ◽

I. McGilvray ◽

S. Gallinger ◽

...

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying

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Pancreatic Serous Cystadenomas Report of 8 Cases with a Mean Follow up of 7 Years

HPB Surgery ◽

10.1155/1996/92853 ◽

1996 ◽

Vol 9 (4) ◽

pp. 215-217 ◽

Cited By ~ 1

Author(s):

Alejandro Fabiani ◽

Gonzalo J. Delía ◽

Roberto De Rosa ◽

María T. Pombo ◽

Oscar Molfino ◽

...

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Acute Cholangitis ◽

Serous Cystadenoma ◽

Malignant Potential ◽

Cystic Tumor ◽

Serous Cystadenomas ◽

Pancreatic Cystic Tumor

Serous cystadenoma of the pancreas are rare tumors and have little or no malignant potential.We report our experience in the management of eight casses of these tumors in the last 22 years. All the patients were women with a mean age of 59 years. All the cysts caused symptoms. Ultrasound and CTscan were useful in the diagnosis of the pancreatic cystic tumor out not in determining the nature of these lesions clear. FNA-biopsy was performed in 6 cases but in only one c se was the diagnosis confirmed. All tumors were resected. Four radical pancreatoduodenectomies, two distal pancreatectomies and two cystectomies were performed. Mean followup was 83.5 months. All patients are alive and with no signs of recurrence. Complications include an external pancreatic fistula, an acute cholangitis and a case of delayed gastric emptying. In all cases the histological diagnosis was serous cystadenoma of the pancreas. We conclude that resection of these tumors is mandatory although they are supposed to be benign, in order to avoid complications and because malignant transformations has been related to nonresective treatment.

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Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

10.21203/rs.3.rs-17682/v2 ◽

2020 ◽

Author(s):

lyu yunxiao ◽

Bin Wang ◽

Yunxiao Cheng ◽

Yueming Xu ◽

WeiBing Du

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Meta Analysis ◽

Operation Time ◽

Bile Leakage ◽

Reoperation Rate ◽

Postoperative Pancreatic Fistula ◽

Controlled Trials ◽

Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

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Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy

10.21203/rs.2.10531/v3 ◽

2020 ◽

Author(s):

Satoshi Hayama ◽

N Senmaru ◽

Satoshi Hirano

Keyword(s):

Gastric Emptying ◽

Pancreatic Fistula ◽

Delayed Gastric Emptying ◽

Frequent Occurrence ◽

Reconstruction Technique ◽

Similar Frequency ◽

Abdominal Complications ◽

Factors Associated ◽

Pancreatic Reconstruction

Abstract Background: The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) . Methods: A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction. Results: The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups. Conclusions: Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

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International Study Group of Pancreatic Surgery Definitions for Postpancreatectomy Complications: Applicability at a High-Volume Center

Scandinavian Journal of Surgery ◽

10.1177/1457496916680944 ◽

2017 ◽

Vol 106 (3) ◽

pp. 216-223 ◽

Cited By ~ 12

Author(s):

N. Dusch ◽

A. Lietzmann ◽

F. Barthels ◽

M. Niedergethmann ◽

F. Rückert ◽

...

Keyword(s):

Intensive Care Unit ◽

Gastric Emptying ◽

Pancreatic Fistula ◽

Pancreatic Surgery ◽

Delayed Gastric Emptying ◽

International Study ◽

Postoperative Pancreatic Fistula ◽

Study Group ◽

Postpancreatectomy Hemorrhage ◽

International Study Group

Introduction: The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity. Methods: Between 2004 and 2014, 769 patients underwent resection. Data were collected in a prospective database. Univariate examination was performed using the χ2-test. Continuous data were tested with the Mann–Whitney U-test. Student’s t-tests and Fisher’s exact tests were performed. Results: A total of 542 patients were included in this study. In all, 91 (16.8%) patients developed postoperative pancreatic fistula, 69 of them clinically relevant grades B and C postoperative pancreatic fistula. Grades B and C postoperative pancreatic fistulas were significantly associated with a longer hospital stay. The postoperative pancreatic fistula grade significantly correlated with re-operation. Totally, 32 (5.9%) patients developed postpancreatectomy hemorrhage. Postpancreatectomy hemorrhage grade was significantly associated with re-operation and 30-day mortality. In all, 14 of 19 patients with grade C postpancreatectomy hemorrhage (73.7%) were re-operated; 3 had a simultaneous postoperative pancreatic fistula C. Grade B postpancreatectomy hemorrhage significantly prolonged hospital stay. Grade C postpancreatectomy hemorrhage significantly prolonged intensive care unit stay. Grade C postpancreatectomy hemorrhage led to longer intensive care unit stay but a shorter hospital stay. Delayed gastric emptying occurred in 131 (24.2%) patients. The delayed gastric emptying grade was significantly associated with re-operation. Nine of the re-operated patients had a simultaneous postoperative pancreatic fistula C. Grades A, B, and C delayed gastric emptying were associated with prolonged hospital- and intensive care unit stay. Conclusion: Delayed gastric emptying is the most common specific complication after pancreas resection, followed by postoperative pancreatic fistula and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery definitions are well applicable in clinical routine and the different grades correlate well with severity of clinical condition, length of hospital or intensive care unit stay, and mortality. Their widespread use can contribute to a more reproducible and reliable comparison of surgical outcomes in pancreas surgery.

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