Does Preoperative Acute Pancreatitis Inevitably Delay Pancreatoduodenectomy in Patients with Periampullary Tumors?

Preoperative acute pancreatitis (PAP) in patients with periampullary tumor can cause technical difficulties when performing pancreatoduodenectomy (PD) but perioperative risks of PAP remain unclear. The purpose of this study was to investigate the impact of PAP on surgical outcomes and determine the optimal timing of PD. Patients undergoing surgery for periampullary tumors between 2009 and 2018 were included. Simple random sampling (1:4) was performed to compare outcomes between the PAP group and the control group. Operative failure was defined as exploration-only or unwanted total pancreatectomy. The rate of operative failure was higher in the PAP group than in the control group (6.6% vs. 0%, p < 0.001). There was no significant difference in postoperative outcomes including complications or in-hospital mortality between the two groups. Surgical outcomes were compared after dividing PAP groups by intervals (2, 3, or 4 weeks) between the onset of PAP and surgery, and there were no differences between the groups. In conclusion, in spite of the increased risk of operation failure, PD could be performed in PAP patients at comparable rates of postoperative complications. Further study is needed to select patients with PAP in proper conditions for performing PD.

Anterior approach in situ resection for total laparoscopic pancreaticoduodenectomy

Background Laparoscopic pancreaticoduodenectomy (LPD) is gaining popularity in last decade. However, it is still technical challenging to perform LPD for patients with large periampullary tumors. Methods From January 2019 to January 2020, 13 cases of LPD were performed via anterior approach. Data were collected prospectively in terms of demographic characteristics (age, gender, body mass index, pathological diagnosis and tumor size), intra-operative variables (operative time, estimated blood loss, transfusion), and post-operative variables (time for oral intake, post-operative hospital stay, and complications). Results There were five male patients and eight female patients included in this study. The median age of these patients was 52.7 ± 14.5 years. The median size of tumors was 7.2 ± 2.9 cm. One patient converted to open surgery because of uncontrollable hemorrhage. The median operative time was 356 ± 47 min. The median estimated blood loss was 325 ± 216 ml. The mean post-operative hospital stay was 12.4 ± 1.9 days. One patient suffered from grade B pancreatic fistula. One patient suffered from delayed gastric emptying which was cured by conservative therapy. 90-day mortality was zero. Conclusions Laparoscopic pancreaticoduodenectomy via anterior approach is safe and feasible for patients with large periampullary tumors. Its oncological benefit requires further investigation.

The Relationship between Nutritional Status and Body Composition with Clinical Parameters, Tumor Stage, CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors

Recent studies have obtained inadequate data on the association between nutritional status, body composition, clinical parameters and tumor stage in patients withpancreatic and periampullary tumors. The purpose of this study was to assess the relationship between nutritional status (NS), body composition (BC) and selected clinical parameters in patients with pancreatic and periampullary cancer, as well as describe the differences between resection and non-resection groups. This is a prospective study of 76 patients with pancreatic and periampullary tumors. We evaluated NS, BMI, body mass loss (BML) and albumin, total protein, CRP, CEA, CA19-9, lipase, amylase, tumor stage, and BC using bioelectrical impedance (BIA). All subjects were divided into resection (n = 59) and non-resection (n = 17) groups. The non-resection group had a worse NS, as well as increased amylase and WBC, compared to the resection. The selected parameters of BC corresponded to BML albumin, TP, NS, age, BMI, Karnofsky, RBC, HCT and HGB. No associations were found between BC with tumor size, CRP, CA19-9, and CEA. We recorded the relationship between metastasis and NRS, as well as tumor size with SGA. The percentage of BML was positively correlated with age and CRP but negatively correlated with RBC, HGB, HCT and anthropometric measurements. We found many statistical correlations with NS and selected parameters, as well as differences between the resection and non-resection group. The detection of early prognostic factors of nutritional impairments would improve the quality of life and reduce the rate of postoperative complications.

Possibilities of CT perfusion in diagnostics of periampullary tumors

Purpose. To study the possibilities of CT perfusion (CTP) in detecting periampullary tumors depending on the anatomical localization, to compare the diagnostic efficiency with the standard CT protocol. Materials and methods. CT scan of the abdominal organs according to the standard protocol and CTP were performed in 229 patients with periampullary tumors. Results. In adenocarcinoma of the pancreas, compared with adenocarcinoma of the major duodenal papilla, BF, BV, MSI (p<0,005) were statistically significantly lower, there were no differences in MTT, TTP, and PS (p>0,005). In distal cholangiocarcinoma, compared with adenocarcinomas of the pancreas and the major duodenal papilla (MDP), the BF, BV and MSI values were statistically significantly higher, the TTP values were lower (p<0,005), there were no differences in the MTT and PS values (p>0,005). Conclusion. CT perfusion is a highly informative method for detecting and determining the anatomical affiliation of periampullary tumors with a sensitivity of 98,7%, a specificity of 98%, and a diagnostic accuracy of 98,4%.