Central versus Distal Pancreatectomy for Benign or Low-Grade Malignant Lesions in the Pancreatic Neck and Proximal Body

2019 ◽  
Vol 85 (11) ◽  
pp. 1239-1245 ◽  
Author(s):  
Yangjun Li ◽  
Yujie Li
Keyword(s):  
Confidence Interval ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Low Grade ◽  
Exocrine Insufficiency ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intra-operative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.

Simplicity and Safety: Minimized Pancreatic Fistula Rate after Distal Pancreatectomy through Pancreas Stump Sutured Fish-Mouth Closure

2018 ◽  
Vol 84 (11) ◽  
pp. 1734-1740
Author(s):  
Michael J. Minarich ◽  
Roderich E. Schwarz
Keyword(s):  
Length Of Stay ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Oncology ◽  
Postoperative Recovery ◽  
Splenic Vessel ◽  
Pancreatic Stump ◽  
Fistula Rate ◽  
Oncology Practice ◽  
Pancreatic Fistula Rate

Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. Seventy-five of 294 pancreatectomy patients underwent DP (26%). There were 33 men and 42 women, with a median age of 61 years (range: 18–85 years). Underlying conditions included cancer (60%) and benign processes (40%). Resections were comprising open DP (64%), laparoscopic DP (21%), and open multivisceral resections (15%). Of 21 cases with postoperative complications (28%, no death), six were PFs (8%, 2 grade A and 4 grade B). The median length of stay was six days (4–24). The PF rate was 2.0 per cent in 50 patients after sutured fish-mouth closures, but 20 per cent in cases using other techniques including stapling ( P = 0.007); no other variable was linked to PF occurrence. Length of stay was linked to complications, resection extent, malignancy, and transfusions (all at P < 0.02), but not to PF. PF rate after DP in this experience is unaffected by splenic vessel resection but seems to be minimized through a sutured fish-mouth closure technique.

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

Pancreatology ◽  
2011 ◽  
Vol 11 (3) ◽  
pp. 362-370 ◽  
Author(s):  
Yanming Zhou ◽  
Chunlian Yang ◽  
Shuangjia Wang ◽  
Jingxi Chen ◽  
Bin Li
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Resection ◽  
Meta Analysis ◽  
Pancreatic Duct Stent ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

Novel Method of Stump Closure for Distal Pancreatectomy with a 75% Reduction in Pancreatic Fistula Rate

2011 ◽  
Vol 16 (3) ◽  
pp. 524-528 ◽  
Author(s):  
Joseph A. Blansfield ◽  
Megan M. Rapp ◽  
Ravi J. Chokshi ◽  
Nicole L. Woll ◽  
Marie A. Hunsinger ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Stump Closure ◽  
Novel Method ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

scholarly journals Prediction of pancreatic fistula after distal pancreatectomy: Is it necessary to place prophylactic drain?

2020 ◽  
Author(s):  
Kazuhiro Suzumura ◽  
Kenjiro Iida ◽  
Hideaki Iwama ◽  
Yusuke Kawabata
Keyword(s):  
Body Mass Index ◽  
Multivariate Analysis ◽  
Confidence Interval ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Body Mass ◽  
Predictive Factors ◽  
Odds Ratio ◽  
Drain Placement ◽  
Pancreatic Thickness

The aim of this study was to determine the predictive factors for pancreatic fistula (PF) after distal pancreatectomy (DP) among preoperative and intraoperative parameters, and to clarify the patients who did not require drain placement. Between July 2009 and April 2017, 102 consecutive patients underwent DP at Hyogo College of Medicine. Preoperative and intraoperative data were collected, and the predictors of PF after DP were identified. PF was identified in 35 (34%) patients. In the multivariate analysis, 3 factors (body mass index [BMI] ≥22.4, contiguous organ resection, and pancreatic thickness ≥11 mm) were found to be independent predictors of PF (odds ratio, 5.7; 95% confidence interval, 1.9-17, p=0.002, odds ratio, 6.7; 95% confidence interval, 1.6-28, p=0.009, odds ratio, 11.6; 95% confidence interval, 3.7-36, p&lt;0.001, respectively). A scoring scale for the prediction of PF was developed. BMI ≥22.4 (score: 1), contiguous organ resection (score: 1), and pancreatic thickness ≥11 mm (score: 2) were included in the scoring scale. Patients with a score of 0 never developed PF, while PF occurred in all patients with a score of 4. BMI ≥22.4, contiguous organ resection, and pancreatic thickness ≥11 mm were predictive factors for PF after DP. No patients with BMI &lt;22.4, no contiguous organ resection, and a pancreatic thickness of &lt;11 mm developed PF after DP, indicating that such patients may not require drain placement.

scholarly journals Protective Effects of Statins Administration in European and North American Patients Infected with COVID-19: A Meta-analysis

2021 ◽  
Author(s):  
Mairi Pucci ◽  
Diletta Onorato ◽  
Giovanni Carpene ◽  
Brandon Michael Henry ◽  
Fabian Sanchis-Gomar ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Statin Therapy ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Protective Role ◽  
Favorable Effect ◽  
Current Evidence ◽  
Severe Illness ◽  
Protective Effects ◽  
Time Data

AbstractSevere acute respiratory syndrome coronavirus 2 has spread rapidly throughout the world, becoming an overwhelming global health emergency. The array of injuries caused by this virus is broad and not limited to the respiratory system, but encompassing also extensive endothelial and systemic tissue damage. Since statins effectively improve endothelial function, these drugs may have beneficial effects in patients with coronavirus disease 2019 (COVID-19). Therefore, this investigation aimed to provide an updated overview on the interplay between statins and COVID-19, with particular focus on their potentially protective role against progression toward severe or critical illness and death. A systematic electronic search was performed in Scopus and PubMed up to present time. Data on statins use and COVID-19 outcomes especially in studies performed in Europe and North America were extracted and pooled. A total of seven studies met our inclusion criteria, totaling 2,398 patients (1,075 taking statins, i.e., 44.8%). Overall, statin usage in Western patients hospitalized with COVID-19 was associated with nearly 40% lower odds of progressing toward severe illness or death (odds ratio: 0.59; 95% confidence interval: 0.35–0.99). After excluding studies in which statin therapy was started during hospital admission, the beneficial effect of these drugs was magnified (odds ratio: 0.51; 95% confidence interval: 0.41–0.64). In conclusion, although randomized trials would be necessary to confirm these preliminary findings, current evidence would support a favorable effect of statins as adjuvant therapy in patients with COVID-19. Irrespective of these considerations, suspension of statin therapy seems highly unadvisable in COVID-19 patients.

scholarly journals Adherence to antihypertensive medications and associated factors among hypertensive patients in Ethiopia: Systematic review and meta-analysis

2020 ◽  
Vol 8 ◽  
pp. 205031212098245
Author(s):  
Assefa Tola Gemeda ◽  
Lemma Demissie Regassa ◽  
Adisu Birhanu Weldesenbet ◽  
Bedasa Taye Merga ◽  
Nanti Legesse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medication Adherence ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Associated Factors ◽  
Antihypertensive Medication ◽  
Meta Analysis ◽  
Group Analysis ◽  
Hypertensive Patients ◽  
Pooled Prevalence

The foundation of controlling hypertension is adherence to antihypertensive medication adherence. This systematic review and meta-analysis aimed to assess the magnitude and associated factors of adherence to antihypertensive medication among adult hypertensive patients in Ethiopia. A comprehensible bibliographic searching was conducted from PubMed, EMBASE, Scopus, and Web of Science core collection. All published and unpublished studies that had been accessible before 31 May 2020, and written in English were eligible. Joanna Briggs Institute assessment tool was used to evaluate the quality of the findings of the included studies. Stata software 16.0 was used to analyze the data. Study-specific estimates were pooled to determine the overall prevalence estimate across studies using a random-effects meta-analysis model. Publication bias and heterogeneity were checked. Fourteen studies with a total of 4938 hypertensive patients were included in the final systematic review and meta-analysis. The pooled prevalence of medication adherence among hypertensive patients in Ethiopia was 65.41% (95% confidence interval: 58.91–71.91). Sub-group analysis shown that the pooled prevalence of medication adherence was the highest (69.07%, 95% confidence interval: 57.83–80.31, I2 = 93.51) among studies using questionnaire technique whereas the lowest in Morisky Medication Adherence Scale eight-items (60.66%, 95% confidence interval: 48.92–72.40, I2 = 97.16). Moreover, medication adherence was associated with the presence of comorbidities (pooled odds ratio = 0.23, 95% confidence interval: 0.07–0.38, p = 0.030, I2 = 54.9%) and knowledge about the disease and its management (pooled odds ratio = 2.98, 95% confidence interval: 1.72–4.24, p = 0.04, I2 = 55.55%) but not with place of residence (pooled odds ratio = 1.22, 95% confidence interval: 0.51–1.93, p = 0.00, I2 = 76.9%). Despite a lack of uniformity among included studies, adherence to antihypertensive medication among the hypertensive population in Ethiopia was moderate. The presence of comorbidities and/or complications reduced the odds of adherence whereas having good knowledge about the disease increased chance of medication adherence among hypertensive patients.

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