Preoperative Ultrasound Elastography (SWE) predicts increased risk of Pancreatic Fistula (POPF) after pancreaticoduodenectomy

Recent literature has shown that various carotid plaque features, other than stenosis, contribute to plaque vulnerability. Features such as surface morphology and plaque composition with distinct components (e.g. intraplaque hemorrhage, lipid core) have been associated with the increased risk of future cerebrovascular events. Ultrasonography constitutes the first line modality for the assessment of carotid disease and has traditionally been used to grade stenosis with high accuracy. Recenttechnological advances such as contrast-enhanced ultrasound and elastography increased the diagnostic yield of ultrasound in assessing the morphology of carotid plaques. The purpose of this review is to present the available literature on ultrasound elastography of the atherosclerotic carotid. Strain and shear wave elastography allow for the characterization of plaque components, thus indicating its nature and importantly, the plaque’s vulnerability. Shear wave elastography indices appear morerobust than Strain indices. Overall, elastography is a feasible method to distinguish vulnerable carotid plaques. There is, however, a need for larger and longer prospective controlled clinical studies in order to validate elastography as an imaging modality used for the detection of unstable carotid plaques.

Download Full-text

Is Ultrasound Elastography Useful in Predicting Clinically Relevant Pancreatic Fistula After Pancreatic Resection?

Pancreas ◽

10.1097/mpa.0000000000001685 ◽

2020 ◽

Vol 49 (10) ◽

pp. 1342-1347

Author(s):

Giovanni Marasco ◽

Claudio Ricci ◽

Francesco Buttitta ◽

Elton Dajti ◽

Federico Ravaioli ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Ultrasound Elastography

Download Full-text

Is rising BMI associated with an increased rate of clinically relevant pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.360 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 360-360

Author(s):

Evan Scott Glazer ◽

Yixuan Zhou ◽

Justin Drake ◽

Jeremiah Lee Deneve ◽

Stephen W Behrman ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Logistic Regression Analysis ◽

Older Age ◽

Ductal Adenocarcinoma ◽

Multivariable Logistic Regression Analysis ◽

Term Survival ◽

Increased Risk

360 Background: Clinically relevant pancreatic fistula (CR-POPF), following distal pancreatectomy (DP) remains a clinical challenge. Prior studies investigating the relationship between body mass index (BMI) and CR-POPF have yielded conflicting results. We examined this relationship utilizing our institutional database and hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who underwent DP for PDAC at a single institution from 2007 to 2018 were retrospectively reviewed. A CR-POPF was defined as ISGPS grade B or C fistula. Uni- and multi-variable logistic regression analysis to assess factors associated with CR-POPF following DP was performed, controlling for factors such as gland texture, operative drain placement, gender, and smoking status. Results: 78 patients met the inclusion criteria. 51% were female, 51% were Caucasian, and the average age was 59 ± 15 years. The median BMI was 26 (interquartile range 24 to 29). Overall, 19% (n = 15) of patients had a CR-POPF. With a mean follow up 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with long-term survival (P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (OR = 0.95, P = 0.015) while increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). After controlling for multiple factors on multivariable logistic regression analysis, BMI (OR = 1.12, P = 0.035) was the only factor associated with development of a CR-POPF while older age (OR = 0.94, P < 0.001) was slightly protective of CR-POPF development. Conclusions: For patients undergoing DP for PDAC, increasing BMI is associated with an increased risk of CR-POPF, independent of other factors. These findings should be considered during preoperative counseling. Although there is no specific cut-off for the association between BMI and CR-POPF, efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI based on this data.

Download Full-text

Pancreaticogastrostomy Prevents Postoperative Pancreatic Fistula of Portal Annular Pancreas During Pancreaticoduodenectomy

International Surgery ◽

10.9738/intsurg-d-16-00044.1 ◽

2016 ◽

Vol 101 (11-12) ◽

pp. 550-553

Author(s):

Ippei Matsumoto ◽

Keiko Kamei ◽

Shumpei Satoi ◽

Takuya Nakai ◽

Yoshifumi Takeyama

Keyword(s):

Portal Vein ◽

Pancreatic Fistula ◽

Dorsal Surface ◽

Uncinate Process ◽

Postoperative Pancreatic Fistula ◽

The Body ◽

Annular Pancreas ◽

Exocrine Function ◽

Portal Annular Pancreas ◽

Increased Risk

Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.

Download Full-text

Increased thyroid malignancy in patients with primary hyperparathyroidism

Endocrine Connections ◽

10.1530/ec-21-0217 ◽

2021 ◽

Author(s):

Luchuan Li ◽

Baoyuan Li ◽

Bin Lv ◽

Weili Liang ◽

Binbin Zhang ◽

...

Keyword(s):

Thyroid Cancer ◽

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Thyroid Nodules ◽

Biological Data ◽

Chinese Patients ◽

Papillary Thyroid ◽

Hormone Levels ◽

Preoperative Ultrasound ◽

Increased Risk

Background: Multiple studies have reported increased incidence of thyroid cancer in patients with primary hyperparathyroidism (PHPT). However, the underlying risk factors of concomitant thyroid cancer in patients with PHPT remain unknown. The primary aim of this study was to examine the records of patients with PHPT to identify characteristics that correlated with the presence of coexisting thyroid nodules, and which may have an implication for the prediction of thyroid cancer. Methods: Medical records of consecutive patients with PHPT (n=318) were reviewed from Jan 2010 to Sep 2020 in two tertiary medical centers in China. Patient clinicopathological and biological data were collected and analyzed. Results: Of a total of 318 patients with PHPT, 105 (33.0%) patients had thyroid nodules and 26 (8.2%) patients were concomitant with thyroid cancer. A total of 38 thyroid nodules taken from 26 patients were pathologically assessed to be well-differentiated papillary thyroid carcinoma (PTC), with 81% being papillary thyroid microcarcinoma (PTMC). In 79% (30/38) of these cancers, thyroid nodules were considered suspicious following preoperative ultrasound. Multinomial logistic regression analysis revealed that female gender was associated with increased risk of thyroid nodules (OR=2.13, 95%CI: 1.13-3.99, p = 0.019), while lower log-transformed parathyroid hormone levels were an independent predictor of thyroid cancer in patients with PHPT (OR=0.50, 95%CI: 0.26-0.93, p = 0.028). Conclusion: In conclusion, we observed a relatively high prevalence of thyroid cancer in our cohort of Chinese patients with PHPT. Evaluation of thyroid nodules by preoperative ultrasound may be advisable in patients with PHPT, particularly for females and patients with modestly elevated serum parathyroid hormone levels.

Download Full-text

Intraoperative Ultrasound Elastography Is Useful for Determining the Pancreatic Texture and Predicting Pancreatic Fistula After Pancreaticoduodenectomy

Pancreas ◽

10.1097/mpa.0000000000001576 ◽

2020 ◽

Vol 49 (6) ◽

pp. 799-805

Author(s):

Yusuke Kawabata ◽

Toshihiro Okada ◽

Hiroko Iijima ◽

Masahiro Yoshida ◽

Hideaki Iwama ◽

...

Keyword(s):

Pancreatic Fistula ◽

Intraoperative Ultrasound ◽

Ultrasound Elastography ◽

Pancreatic Texture

Download Full-text

Rising BMI is Associated with Increased Rate of Clinically Relevant Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Adenocarcinoma

The American Surgeon ◽

10.1177/000313481908501232 ◽

2019 ◽

Vol 85 (12) ◽

pp. 1376-1380

Author(s):

Yixuan Zhou ◽

Justin Drake ◽

Jeremiah L. Deneve ◽

Stephen W. Behrman ◽

Paxton V. Dickson ◽

...

Keyword(s):

Logistic Regression ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

International Study ◽

Older Age ◽

Ductal Adenocarcinoma ◽

Multivariable Logistic Regression Analysis ◽

Increased Risk ◽

The Relationship

Clinically relevant pancreatic fistula (CR-POPF), after distal pancreatectomy (DP), remains a clinical challenge. Prior studies investigating the relationship between BMI and CR-POPF have yielded conflicting results. We hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Patients who underwent DP for PDAC at a single institution from 2006 to 2018 were retrospectively reviewed. A CR-POPF was defined as International Study Group of Pancreatic Surgery (ISGPS) grade B or C fistula. Uni- and multivariable logistic regression analysis assessed factors associated with CR-POPF after DP. Seventy-eight patients met the inclusion criteria, 51 per cent were female, 51 per cent were white, and the average age was 59 ± 15 years. The median BMI was 26 (IQR 24–29). Of all, 19 per cent (n = 15) of patients had a CR-POPF. With a mean follow-up of 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with survival ( P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (odds ratio (OR) = 0.95, P = 0.015). Increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). On multivariate analysis, after controlling for multiple factors, BMI (OR = 1.12, P = 0.035) was the only factor associated with the development of a CR-POPF, whereas older age (OR = 0.94, P < 0.001) was slightly protective. Increasing BMI is associated with an increased risk of CR-POPF after DP for PDAC. These findings should be considered during preoperative counseling. Efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI.

Download Full-text

The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study

Healthcare ◽

10.3390/healthcare10010126 ◽

2022 ◽

Vol 10 (1) ◽

pp. 126

Author(s):

Hao-Wei Kou ◽

Chih-Po Hsu ◽

Yi-Fu Chen ◽

Jen-Fu Huang ◽

Shih-Chun Chang ◽

...

Keyword(s):

Pancreatic Fistula ◽

Predictive Factors ◽

Biliary Drainage ◽

Financial Burden ◽

Failure To Thrive ◽

Postoperative Recovery ◽

Postoperative Pancreatic Fistula ◽

Increased Risk ◽

Study Characteristics ◽

Unplanned Visit

Background: Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients’ postoperative recovery and are associated with increased financial burden and morbidity. The aim of this study is to identify predictive factors related to these events and target the potentially preventable UHV and readmissions. Methods: We enrolled 518 patients in this study. Characteristics were compared between patients with or without UHV and readmissions. Results: The unplanned visit and readmission rate was 23.4% and 15.8%, respectively. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. The most common reason for readmission was an infection, followed by failure to thrive. The overall mortality rate in the readmission group was 4.9%. Conclusions: UHV and readmissions remain common among patients undergoing PD. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality.

Download Full-text