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Martín S, Secanella L, Sorribas M, Peláez N, Salord S, Lopez-Urdiales R, Fabregat J, Busquets J. Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy. Cir Esp 2023; 101:657-664. [PMID: 36716958 DOI: 10.1016/j.cireng.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/21/2022] [Accepted: 10/30/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.
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Affiliation(s)
- S Martín
- General and Digestive Surgery Service, Viladecans Hospital, Viladecans, Spain
| | - Ll Secanella
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Sorribas
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Peláez
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Salord
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Department of Digestive Diseases Unit. Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Lopez-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital, Barcelona, Spain
| | - J Fabregat
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - J Busquets
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
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2
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2022; 100:125-132. [PMID: 35221240 DOI: 10.1016/j.cireng.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
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3
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2021; 100:S0009-739X(21)00029-4. [PMID: 33714556 DOI: 10.1016/j.ciresp.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
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Mora-Oliver I, Garcés-Albir M, Dorcaratto D, Muñoz-Forner E, Izquierdo Moreno A, Carbonell-Aliaga MP, Sabater L. Pancreatoduodenectomy with artery-first approach. MINERVA CHIR 2019; 74:226-236. [PMID: 30600965 DOI: 10.23736/s0026-4733.18.07944-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
"Artery-first approach" encompasses different aspects for the surgical treatment of pancreatic cancer. It is a surgical technique or set of techniques which share in common the dissection of the main arterial vasculature involved in pancreatic cancer, before any irreversible surgical step is performed. On the other hand it represents the need for a meticulous dissection of the arterial planes and clearing of the retropancreatic tissue between the superior mesenteric artery, the common hepatic artery and portal vein in an attempt to achieve R0 resections. The recent expansion of this approach is based mainly on three factors: venous involvement should not be considered a contraindication for resection, most of the pancreatic resections performed with a standard procedure may be in fact non-oncological (R1) resections and the postero-medial or vascular margin is the most frequently invaded by the tumor. This review aimed to summarize and update the artery-first approach in pancreaticoduodenectomy.
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Affiliation(s)
- Isabel Mora-Oliver
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Marina Garcés-Albir
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Dimitri Dorcaratto
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Elena Muñoz-Forner
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Ana Izquierdo Moreno
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Mari P Carbonell-Aliaga
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain.,Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Luis Sabater
- Liver, Biliary and Pancreatic Unit, Department of General Surgery, Hospital Clínico, University of Valencia, Spain - .,Biomedical Research Institute INCLIVA, Valencia, Spain
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Busquets J, Martín S, Fabregat J, Secanella L, Pelaez N, Ramos E. Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial). Br J Surg 2018; 106:46-54. [PMID: 30507039 DOI: 10.1002/bjs.11023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/14/2018] [Accepted: 09/25/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is the most important cause of an extended hospital stay after pancreatoduodenectomy. Reports suggest that a Roux-en-Y gastroenteric anastomosis may have lower incidence of DGE than a Billroth II reconstruction. The primary aim of this RCT was to compare Billroth II (single loop) and Roux-en-Y (double loop) after pancreatoduodenectomy to determine whether Roux-en-Y reconstruction is associated with a lower incidence of DGE. Secondary endpoints were postoperative complications. METHODS This was a randomized unblinded single-centre trial without masked evaluation of the main outcome. Patients undergoing pancreatoduodenectomy between 2013 and 2015 were randomized to undergo one of two types of gastroenteric anastomosis for reconstruction. RESULTS A total of 80 patients were randomized, 40 in each group. The incidence of DGE was the same in patients undergoing Billroth II or Roux-en-Y gastroenteric anastomosis (both 18 of 40 patients; P = 1·000). The grade of DGE was also similar in the Billroth II and Roux-en-Y groups (grade A, both 10 of 40; grade B, 5 of 40 versus 6 of 40; grade C, 3 of 40 versus 2 of 40; P = 0·962). The mortality rate was 3 per cent, with no significant difference between the two groups. There were no differences in the overall rate of postoperative morbidity, relaparotomy rate or duration of hospital stay. CONCLUSION The incidence and severity of DGE does not differ between single- or double-loop gastroenteric anastomosis performed after pancreatoduodenectomy. Registration number: NCT00915863 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J Busquets
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Martín
- Cirurgia General i Digestiva, Hospital Viladecans, Barcelona, Spain
| | - J Fabregat
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Secanella
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Pelaez
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Ramos
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, Spain
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Busquets J, Fabregat J, Verdaguer H, Laquente B, Pelaez N, Secanella L, Leiva D, Serrano T, Cambray M, Lopez-Urdiales R, Ramos E. Initial Experience in the Treatment of "Borderline Resectable" Pancreatic Adenocarcinoma. Cir Esp 2017; 95:447-456. [PMID: 28992935 DOI: 10.1016/j.ciresp.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/30/2017] [Accepted: 07/09/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION A borderline resectable group (APBR) has recently been defined in adenocarcinoma of the pancreas. The objective of the study is to evaluate the results in the surgical treatment after neoadjuvancy of the APBR. METHOD Between 2010 and 2014, we included patients with APBR in a neoadjuvant and surgery protocol, staged by multidetector computed tomography (MDCT). Treatment with chemotherapy was based on gemcitabine and oxaliplatin. Subsequently, MDCT was performed to rule out progression, and 5-FU infusion and concomitant radiotherapy were given. MDCT and resection were performed in absence of progression. A descriptive statistical study was performed, dividing the series into: surgery group (GR group) and progression group (PROG group). RESULTS We indicated neoadjuvant treatment to 22 patients, 11 of them were operated, 9 pancreatoduodenectomies, and 2 distal pancreatectomies. Of the 11 patients, 7 required some type of vascular resection; 5 venous resections, one arterial and one both. No postoperative mortality was recorded, 7 (63%) had any complications, and 4 were reoperated. The median postoperative stay was 17 (7-75) days. The pathological study showed complete response (ypT0) in 27%, and free microscopic margins (R0) in 63%. At study clossure, all patients had died, with a median actuarial survival of 13 months (9,6-16,3). The median actuarial survival of the GR group was higher than the PROG group (25 vs. 9 months; p < 0.0001). CONCLUSION The neoadjuvant treatment of APBR allows us to select a group of patients in whom resection achieves a longer survival to the group in which progression is observed. Post-adjuvant pancreatic resection requires vascular resection in most cases.
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Affiliation(s)
- Juli Busquets
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, España.
| | - Juan Fabregat
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, España
| | - Helena Verdaguer
- Servei d'Oncologia Mèdica, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España
| | - Berta Laquente
- Servei d'Oncologia Mèdica, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España
| | - Núria Pelaez
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, España
| | - Luis Secanella
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, España
| | - David Leiva
- Servei de Radiodiagnòstic, Hospital Universitari de Bellvitge, Barcelona, España
| | - Teresa Serrano
- Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, Barcelona, España
| | - María Cambray
- Servei d'Oncologia Radioteràpica, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España
| | | | - Emilio Ramos
- Unitat de Cirurgia Hepatobiliopancreàtica i Trasplantament Hepàtic, Hospital Universitari de Bellvitge, Barcelona, España
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Busquets J, Fabregat J, Verdaguer H, Laquente B, Pelaez N, Secanella L, Leiva D, Serrano T, Cambray M, Lopez-Urdiales R, Ramos E. Initial Experience in the Treatment of “Borderline Resectable” Pancreatic Adenocarcinoma. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.cireng.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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8
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Has survival improved following resection for pancreatic adenocarcinoma? Am J Surg 2017; 214:341-346. [DOI: 10.1016/j.amjsurg.2017.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 12/22/2022]
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9
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Morales Soriano R, Esteve Pérez N, Tejada Gavela S, Cuadrado García Á, Rodríguez Pino JC, Morón Canis JM, Molina Romero X, Muñoz Pérez J, González Argente X. Outcomes of an enhanced recovery after surgery programme for pancreaticoduodenectomy. Cir Esp 2015; 93:509-15. [PMID: 26072690 DOI: 10.1016/j.ciresp.2015.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/12/2015] [Accepted: 04/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programs in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS program for PD patients in our hospital, and second to analyze the postoperative results. METHODS A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS program. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilization. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PD patients with a standard postoperative management. RESULTS A total of 85 pancreatoduodenectomies were analyzed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperationss, and readmissions. ERAS group had a lower morbidity rate than the control group (32 vs. 48%; P=.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved. CONCLUSIONS ERAS programs may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs.
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Affiliation(s)
- Rafael Morales Soriano
- Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España.
| | - Neus Esteve Pérez
- Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España
| | - Silvia Tejada Gavela
- Departamento de Biología y Ciencias de la Salud, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | | | - José Carlos Rodríguez Pino
- Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España
| | - José Miguel Morón Canis
- Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España
| | - Xavier Molina Romero
- Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España
| | - José Muñoz Pérez
- Servicio de Cirugía General y Digestivo, Hospital Son Llátzer, Palma de Mallorca, Baleares, España
| | - Xavier González Argente
- Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España
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10
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Sabater L, García-Granero A, Escrig-Sos J, Gómez-Mateo MDC, Sastre J, Ferrández A, Ortega J. Outcome Quality Standards in Pancreatic Oncologic Surgery. Ann Surg Oncol 2014; 21:1138-46. [DOI: 10.1245/s10434-013-3451-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Indexed: 12/16/2022]
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11
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Zárate Moreno FA, Oms Bernad LM, Mato Ruiz R, Balaguer del Ojo C, Sala Pedrós J, Campillo Alonso F. [Efficacy of octreotide in the treatment of chyle fistulas associated with pancreatic disease]. Cir Esp 2012; 91:237-42. [PMID: 23228417 DOI: 10.1016/j.ciresp.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 09/13/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A chyle fistula is an uncommon complication following abdominal and pancreatic surgery, particularly in the retroperitoneal compartment. It can also appear as a complication of a severe acute pancreatitis. Medical treatment is the initial approach, but resolution is often slow. Somatostatin or octreotide can help in accelerating the resolution of fistulae. PATIENTS AND METHODS Patients developing a chyle fistula (output > 100ml/24h, normal amylase levels and triglyceride concentrations above 110mg/dl) associated with pancreatic disorders were treated with oral intake restriction and parenteral nutrition, followed by subcutaneous octreotide 0.1mg/8h. RESULTS Four female patients from 55 to 80 years old, underwent pancreatic surgery or presented with an acute pancreatitis, were treated. Chyle fistulae ranging from 100 to 2,000ml/24h were treated with octreotide, being resolved within five to seven days. No recurrence has been found in a 2 to 4 years follow up. CONCLUSIONS We have found that chyle fistula medical treatment is often related to a slow resolution, somatostatin or octreotide administration dramatically reduces its duration. Other previously reported studies have also shown that the quick onset of such treatment can accelerate the whole process, leading to a shorter recovery and lower hospital costs.
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Affiliation(s)
- Fabián A Zárate Moreno
- Servicio de Cirugía General y del Aparato Digestivo, Consorci Sanitari de Terrassa, Tarrasa, Barcelona, Spain
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Duodenopancreatectomía en ancianos. Evaluación de resultados. Cir Esp 2012; 90:369-75. [DOI: 10.1016/j.ciresp.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 02/14/2012] [Indexed: 02/01/2023]
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Respuesta de los autores. Cir Esp 2011. [DOI: 10.1016/j.ciresp.2011.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Morera-Ocón FJ. Controversias en la cirugía del cáncer de páncreas. Cir Esp 2011; 89:411; author reply 412. [DOI: 10.1016/j.ciresp.2011.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
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