Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinoma

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

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Prognostic Nomogram for Patients With Pancreatic Ductal Adenocarcinoma of Pancreatic Head After Pancreaticoduodenectomy

Clinical Medicine Insights Oncology ◽

10.1177/11795549211024149 ◽

2021 ◽

Vol 15 ◽

pp. 117955492110241

Author(s):

Hongkai Zhuang ◽

Zixuan Zhou ◽

Zuyi Ma ◽

Shanzhou Huang ◽

Yuanfeng Gong ◽

...

Keyword(s):

Regression Analysis ◽

Pancreatic Ductal Adenocarcinoma ◽

Perineural Invasion ◽

Cox Regression ◽

Area Under The Curve ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

R0 Resection ◽

Cox Regression Analysis ◽

Ajcc Stage

Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) of pancreatic head remains poor, even after potentially curative R0 resection. The aim of this study was to develop an accurate model to predict patients’ prognosis for PDAC of pancreatic head following pancreaticoduodenectomy. Methods: We retrospectively reviewed 112 patients with PDAC of pancreatic head after pancreaticoduodenectomy in Guangdong Provincial People’s Hospital between 2014 and 2018. Results: Five prognostic factors were identified using univariate Cox regression analysis, including age, histologic grade, American Joint Committee on Cancer (AJCC) Stage 8th, total bilirubin (TBIL), CA19-9. Using all subset analysis and multivariate Cox regression analysis, we developed a nomogram consisted of age, AJCC Stage 8th, perineural invasion, TBIL, and CA19-9, which had higher C-indexes for OS (0.73) and RFS (0.69) compared with AJCC Stage 8th alone (OS: 0.66; RFS: 0.67). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the nomogram for OS and RFS were significantly higher than other single parameter, which are AJCC Stage 8th, age, perineural invasion, TBIL, and CA19-9. Importantly, our nomogram displayed higher C-index for OS than previous reported models, indicating a better predictive value of our model. Conclusions: A simple and practical nomogram for patient prognosis in PDAC of pancreatic head following pancreaticoduodenectomy was established, which shows satisfactory predictive efficacy and deserves further evaluation in the future.

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Comment on “Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma by Crippa et al.”

Annals of Surgery ◽

10.1097/sla.0000000000005275 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ingrid Garajová ◽

Rita Balsano ◽

Valentina Donati ◽

Letizia Gnetti ◽

Mjriam Capula ◽

...

Keyword(s):

Perineural Invasion ◽

Pancreatic Head ◽

Disease Recurrence ◽

Ductal Adenocarcinoma

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Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors

Surgical Endoscopy ◽

10.1007/s00464-018-6488-2 ◽

2018 ◽

Vol 33 (2) ◽

pp. 633-638 ◽

Cited By ~ 7

Author(s):

Jun Cao ◽

Guo-lin Li ◽

Jin-xing Wei ◽

Wei-Bang Yang ◽

Chang-zhen Shang ◽

...

Keyword(s):

Surgical Approach ◽

Malignant Tumors ◽

Pancreatic Head ◽

Low Grade ◽

Pancreatic Head Resection

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Pancreatic exocrine function after pancreatic head resection using stable isotope

Suizo ◽

10.2958/suizo.32.687 ◽

2017 ◽

Vol 32 (4) ◽

pp. 687-692

Author(s):

Hironobu YASUOKA ◽

Akihiko HORIGUCHI ◽

Masahiro ITO ◽

Yukio ASANO ◽

Toki KAWAI

Keyword(s):

Stable Isotope ◽

Pancreatic Head ◽

Pancreatic Exocrine Function ◽

Exocrine Function ◽

Pancreatic Head Resection ◽

Pancreatic Exocrine

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Factors affecting overall survival in ductal adenocarcinoma of the pancreatic head. Experience of one center

Malignant tumours ◽

10.18027/2224-5057-2021-11-1-20-28 ◽

2021 ◽

Vol 11 (1) ◽

pp. 20-28

Author(s):

D. M. Kuchin ◽

Ya. I. Kolesnik ◽

H. G. Torgomyan ◽

V. E. Zagainov

Keyword(s):

Overall Survival ◽

Adjuvant Chemotherapy ◽

Vascular Invasion ◽

Survival Rates ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

Factors Affecting ◽

Poorly Differentiated ◽

Well Differentiated ◽

Major Factors

Purpose. To identify major factors affecting the overall survival (OS). To select the cohort of patients with the best prognosis.Materials and methods. A retrospective analysis included data of 268 patients, 128 men and 140 women, with median age of 59±10,53 (30 to 83) years. For multivariate analysis of survival, patients were selected who underwent pancreaticoduodenectomy (PD) for ductal adenocarcinoma of the pancreatic head.Results. Our study demonstrated that histologically verified vascular invasion (detected only in 30 % of patients who underwent PD with resection of the major vessels) statistically significantly affected the OS. The increased CA19-9 level over 500 U / L (detected in 32,3 % of cases) is the factor that significantly worsens the OS. Patients with high grade adenocarcinoma have significantly better survival rates compared with patients who have moderately or poorly differentiated adenocarcinoma (p = 0.014; median 26 months, 95 % CI 4.4–47.6 versus median 17 months, 95 % CI 15–19, an median: 13 months, 95 % CI 5–21, respectively). Also, the use of adjuvant chemotherapy has a positive effect on long-term outcomes (p = 0.0001; median 26 months, 95 % CI 21.7–30.3 versus median 13 months, 95 % CI 11.3–14.7).Conclusion. A well-differentiated tumor and the use of adjuvant chemotherapy significantly increase the OS of patients. Poorly differentiated tumor, CA19-9 level over 500 U / mL and the histologically confirmed vascular invasion significantly worsen the prognosis of these patients.

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