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Justo Alonso I, Marcacuzco Quinto A, Caso Maestro O, Alonso Murillo L, Rioja Conde P, Fernández Fernández C, Jiménez Romero C. Whipple's cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy. Retrospective study. Cir Esp 2024; 102:265-274. [PMID: 38493929 DOI: 10.1016/j.cireng.2024.02.007] [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: 01/18/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Controversy exists in the literature as to the best technique for pancreaticoduodenectomy (PD), whether pyloric preservation (PP-CPD) or Whipple's technique (with antrectomy [W-CPD]), the former being associated with a higher frequency of delayed gastric emptying (DGE). METHODS Retrospective and comparative study between PP-CPD technique (n = 124 patients) and W-CPD technique (n = 126 patients), in patients who were operated for tumors of the pancreatic head and periampullary region between the period 2012 and 2023. RESULTS Surgical time was longer, although not significant, with the W-CPD technique. Pancreatic and peripancreatic tumor invasion (p = 0.031) and number of lymph nodes resected (p < 0.0001) reached statistical significance in W-CPD, although there was no significant difference between the groups in terms of lymph node tumor invasion. Regarding postoperative morbimortality (medical complications, postoperative pancreatic fistula [POPF], hemorrhage, RVG, re-interventions, in-hospital mortality, Clavien-Dindo complications), ICU and hospital stay, no statistically significant differences were observed between the groups. During follow-up, no significant differences were observed between the groups for morbidity and mortality at 90 days and survival at 1, 3 and 5 years. Binary logistic regression analysis for DGE showed that binary relevant POPF grade B/C was a significant risk factor for DGE. CONCLUSIONS Postoperative morbidity and mortality and long-term survival were not significantly different with PP-CPD and W-CPD, but POPF grade B/C was a risk factor for DGE grade C.
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Affiliation(s)
- Iago Justo Alonso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Alberto Marcacuzco Quinto
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Oscar Caso Maestro
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Laura Alonso Murillo
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Paula Rioja Conde
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Clara Fernández Fernández
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Carlos Jiménez Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Instituto de Investigación (imas12), Spain; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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Justo Alonso I, Alonso Murillo L, Marcacuzco Quinto A, Caso Maestro Ó, Rioja Conde P, Fernández C, Jiménez Romero C. Cephalic pancreatoduodenectomy in octogenarian patients with pancreatic tumors. Cir Esp 2023; 101:599-608. [PMID: 37541325 DOI: 10.1016/j.cireng.2022.10.018] [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: 05/18/2022] [Accepted: 10/30/2022] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Current literature supports the claim that performing a cephalic pancreaticoduodenectomy (CPD) as treatment for pancreatic cancer (PC) is associated with an increase in median survival, both in octogenarian (≥80 years) patients as well as younger patients. METHODS This is a retrospective and comparative trial, comparing results for CPD performed on 30 patients ≥80 years with PC and 159 patients <80 years. RESULTS The patients in the octogenarian group showed a significantly higher rate of preoperative cardiovascular morbidity and a more aggressive tumoral behaviour, including more significant preoperative anemia, jaundice and levels of CA 19-9, higher vascular and neural invasion, and a lower rate of R0 resection despite using the same surgical technique. There were no significant differences in terms of postoperative complications. Postoperative mortality was similar in both groups (3.3% in octogenarians vs 3.1% in patients <80 years). Mortality during follow-up was mainly due to tumour recurrence, cardiovascular complications and COVID-19 in 2 elderly patients. Actuarial survival at 1, 3 and 5 years was significantly larger for patients <80 years old, as compared to octogenarians (85.9%, 61.1% and 39.2% versus 72.7%, 28.9% and 9.6%, respectively; P = 0.001). The presence of a pancreatic fistula and not using external Wirsung stenting were significantly associated with 90-day postoperative mortality after a CPD. CONCLUSIONS Morbidity and mortality post-CPD is similar in octogenarians and patients younger than 80, although long-term survival is shorter due to more aggressive tumours and comorbidities associated with older age.
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Affiliation(s)
- Iago Justo Alonso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
| | - Laura Alonso Murillo
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
| | - Alberto Marcacuzco Quinto
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
| | - Óscar Caso Maestro
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
| | - Paula Rioja Conde
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
| | - Clara Fernández
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
| | - Carlos Jiménez Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain.
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Jiménez Romero C, Marcacuzco Quinto A, Caso Maestro Ó, Justo Alonso I. Reply to Letter to the Editor. Cir Esp 2022; 100:457-458. [PMID: 35525483 DOI: 10.1016/j.cireng.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Carlos Jiménez Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina de la Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre, CIBERES, Madrid, Spain.
| | - Alberto Marcacuzco Quinto
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina de la Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre, CIBERES, Madrid, Spain
| | - Óscar Caso Maestro
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina de la Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre, CIBERES, Madrid, Spain
| | - Iago Justo Alonso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina de la Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre, CIBERES, Madrid, Spain
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Díaz-Vallejo JA, Rodríguez-Gutiérrez MM, Rodríguez-Betancourt DA, Lozada-Martínez ID. A commentary on "Cephalic duodenopancreatectomy and external tutoring of the Wirsung duct. Results of a series of 80 consecutive cases". Cir Esp 2022; 100:186-187. [PMID: 35302936 DOI: 10.1016/j.cireng.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | | | | | - Ivan David Lozada-Martínez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cra. 50 #24-120, Cartagena, Colombia
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Respuesta a Carta al Director. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Díaz-Vallejo JA, Rodríguez-Gutiérrez MM, Rodríguez-Betancourt DA, Lozada-Martínez ID. A commentary on "Cephalic duodenopancreatectomy and external tutoring of the Wirsung duct. Results of a series of 80 consecutive cases". Cir Esp 2021; 100:S0009-739X(21)00265-7. [PMID: 34565523 DOI: 10.1016/j.ciresp.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/20/2022]
Affiliation(s)
| | | | | | - Ivan David Lozada-Martínez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cra. 50 #24-120, Cartagena, Colombia
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