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Yong TL, Malik H, Gold G. How to do a laparoscopic pancreaticoduodenectomy. ANZ J Surg 2023; 93:1024-1026. [PMID: 36825669 DOI: 10.1111/ans.18352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
This paper describes our technique of laparoscopic pancreaticoduodenectomy and our experience in performing this procedure.
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Affiliation(s)
- Tuck Leong Yong
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Hassan Malik
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Grace Gold
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
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Orlas CP, Herrera-Escobar JP, Zogg CK, Serna JJ, Meléndez JJ, Gómez A, Martínez D, Parra MW, García AF, Rosso F, Pino LF, Gonzalez A, Ordoñez CA. Chest Trauma Outcomes: Public Versus Private Level I Trauma Centers. World J Surg 2021; 44:1824-1834. [PMID: 31993723 DOI: 10.1007/s00268-020-05400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma center (Pu-TC) and one private trauma center (Pri-TC). METHODS Patients with thoracic trauma admitted from January 2012 to December 2018 at two level I trauma centers (Pu-TC: Hospital Universitario del Valle, Pri-TC: Fundación Valle del Lili) in Cali, Colombia, were included. Multivariable logistic regression was used to assess for differences in in-hospital mortality, adjusting for relevant demographic and clinical characteristics. RESULTS A total of 482 patients were identified; 300 (62.2%) at the Pri-TC and 182 (37.8%) at the Pu-TC. Median age was 27 years (IQR 21-36) and median Injury Severity Score was 25 (IQR 16-26). 456 patients (94.6%) were male, and the majority had penetrating trauma [total 465 (96.5%); Pri-TC 287 (95.7%), Pu-TC 179 (98.4%), p 0.08]. All patients arrived at the emergency room with unstable hemodynamics. There were no statistically significant differences in post-operative complications, including retained hemothorax [Pri-TC 19 vs. Pu-TC 18], pneumonia [Pri-TC 14 vs. Pu-TC 14], empyema [Pri-TC 13 vs. Pu-TC 13] and mediastinitis [Pri-TC 6 vs. Pu-TC 2]. Logistic regression did, however, show a higher odds of mortality when patients were treated at the Pu-TC [OR 2.27 (95% CI 1.34-3.87, p < 0.001]. CONCLUSIONS Our study found significant statistical differences in clinical outcomes between patients treated at a Pu-TC and Pri-TC. The results are intended to stimulate discussions to better understand reasons for outcome variability and ways to reduce it.
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Affiliation(s)
- Claudia P Orlas
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA.
- Clinical Research Center, Fundación Valle del Lili, Carrera 98, #18-49, Cali, Colombia.
| | - Juan Pablo Herrera-Escobar
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA
| | - José J Serna
- Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia
- Fundación Valle del Lili, Departamento de Cirugia de Trauma y Emergencias, Cali, Colombia
| | - Juan J Meléndez
- Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia
| | - Alexandra Gómez
- Facultad de ciencias de la salud, Universidad del Valle, Cali, Colombia
| | - Diana Martínez
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - Michael W Parra
- Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA
| | - Alberto F García
- Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia
- Fundación Valle del Lili, Departamento de Cirugia de Trauma y Emergencias, Cali, Colombia
| | - Fernando Rosso
- Fundación Valle del Lili, Departamento de Infectologia, Universidad Icesi, Cali, Colombia
| | - Luis Fernando Pino
- Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia
| | - Adolfo Gonzalez
- Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia
| | - Carlos A Ordoñez
- Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia.
- Fundación Valle del Lili, Departamento de Cirugia de Trauma y Emergencias, Cali, Colombia.
- Clinical Research Center, Fundación Valle del Lili, Carrera 98, #18-49, Cali, Colombia.
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Pancreatoduodenectomy With Arterial Resection for Locally Advanced Pancreatic Cancer of the Head: A Systematic Review. Pancreas 2020; 49:621-628. [PMID: 32433398 DOI: 10.1097/mpa.0000000000001551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The development of increasingly effective chemotherapy regimens and increasing tumor necrosis is allowing radical pancreatectomy to be re-evaluated. This systematic review examines the outcome of patients with locally advanced cancer of the pancreatic head after pancreatectomy with arterial resection. Electronic searches were performed on PubMed and Medline databases between January 2000 and December 2018. The end points were to determine the safety and overall survival after arterial resection in pancreatectomy. Thirteen studies with 467 patients were included. Celiac, hepatic, mesenteric, and splenic arteries were resected across all studies. The median overall morbidity was 52% (range, 37%-100%) and with major complications occurring in a median of 25% (range, 12%-54%) of patients. The median 90-day mortality was 5% (range, 0%-17%). R0 was achieved in 66% (range, 43%-100%) and R1 in 31% (range, 0%-74%). The median survival was 17 (range, 7-29) months with a 1- and 3-year survival of 59% (range, 16%-92%) and 17% (range, 0%-13%), respectively. Pancreatectomy with arterial resection may be safely performed in high-volume centers with acceptable survival results in highly selected patients. Pooling of data through a multi-institutional registry will allow a more accurate assessment of the safety and efficacy of this treatment strategy.
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Maharaj AD, Holland JF, Scarborough RO, Evans SM, Ioannou LJ, Brown W, Croagh DG, Pilgrim CHC, Kench JG, Lipton LR, Leong T, McNeil JJ, Nikfarjam M, Aly A, Burton PR, Cashin PA, Chu J, Duong CP, Evans P, Goldstein D, Haydon A, Hii MW, Knowles BPF, Merrett ND, Michael M, Neale RE, Philip J, Porter IWT, Smith M, Spillane J, Tagkalidis PP, Zalcberg JR. The Upper Gastrointestinal Cancer Registry (UGICR): a clinical quality registry to monitor and improve care in upper gastrointestinal cancers. BMJ Open 2019; 9:e031434. [PMID: 31575580 PMCID: PMC6773358 DOI: 10.1136/bmjopen-2019-031434] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Upper Gastrointestinal Cancer Registry (UGICR) was developed to monitor and improve the quality of care provided to patients with upper gastrointestinal cancers in Australia. PARTICIPANTS It supports four cancer modules: pancreatic, oesophagogastric, biliary and primary liver cancer. The pancreatic cancer (PC) module was the first module to be implemented, with others being established in a staged approach. Individuals are recruited to the registry if they are aged 18 years or older, have received care for their cancer at a participating public/private hospital or private clinic in Australia and do not opt out of participation. FINDINGS TO DATE The UGICR is governed by a multidisciplinary steering committee that provides clinical governance and oversees clinical working parties. The role of the working parties is to develop quality indicators based on best practice for each registry module, develop the minimum datasets and provide guidance in analysing and reporting of results. Data are captured from existing data sources (population-based cancer incidence registries, pathology databases and hospital-coded data) and manually from clinical records. Data collectors directly enter information into a secure web-based Research Electronic Data Capture (REDCap) data collection platform. The PC module began with a pilot phase, and subsequently, we used a formal modified Delphi consensus process to establish a core set of quality indicators for PC. The second module developed was the oesophagogastric cancer (OGC) module. Results of the 1 year pilot phases for PC and OGC modules are included in this cohort profile. FUTURE PLANS The UGICR will provide regular reports of risk-adjusted, benchmarked performance on a range of quality indicators that will highlight variations in care and clinical outcomes at a health service level. The registry has also been developed with the view to collect patient-reported outcomes (PROs), which will further add to our understanding of the care of patients with these cancers.
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Affiliation(s)
- Ashika D Maharaj
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer F Holland
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ri O Scarborough
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Liane J Ioannou
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | | | - James G Kench
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John J McNeil
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Austin Health, Melbourne, Victoria, Australia
| | - Paul R Burton
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cuong P Duong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Evans
- Peninsula Health, Melbourne, Victoria, Australia
| | - David Goldstein
- Nelune Comprehensive Cancer Centre, Prince of Wales, Randwick, New South Wales, Australia
| | | | - Michael W Hii
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Neil D Merrett
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Michael Michael
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rachel E Neale
- Population Health Division, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | - Marty Smith
- Alfred Health, Melbourne, Victoria, Australia
| | - John Spillane
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - John R Zalcberg
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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