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Callejas GH, Concon MM, Rezende AQMD, Chaim EA, Callejas-Neto F, Cazzo E. PANCREATICODUODENECTOMY WITH VENOUS RESECTION: AN ANALYSIS OF 30-DAY MORBIDITY AND MORTALITY. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:246-251. [PMID: 31633719 DOI: 10.1590/s0004-2803.201900000-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/17/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.
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Affiliation(s)
- Guilherme Hoverter Callejas
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Matheus Mathedi Concon
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | | | - Elinton Adami Chaim
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Francisco Callejas-Neto
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Everton Cazzo
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
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Rezende AQDM, Dutra JPS, Gestic MA, Utrini MP, Callejas-Neto F, Chaim EA, Cazzo E. PANCREATICODUODENECTOMY: IMPACT OF THE TECHNIQUE ON OPERATIVE OUTCOMES AND SURGICAL MORTALITY. ACTA ACUST UNITED AC 2019; 32:e1412. [PMID: 30624521 PMCID: PMC6323629 DOI: 10.1590/0102-672020180001e1412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a procedure associated with significant morbidity and mortality. Initially described as gastropancreaticoduodenectomy (GPD), the possibility of preservation of the gastric antrum and pylorus was described in the 1970s. AIM To evaluate the mortality and operative variables of PD with or without pyloric preservation and to correlate them with the adopted technique and surgical indication. METHOD Retrospective cohort on data analysis of medical records of individuals who underwent PD from 2012 through 2017. Demographic, anthropometric and operative variables were analyzed and correlated with the adopted technique (GPD vs. PD) and the surgical indication. RESULTS Of the 87 individuals evaluated, 38 (43.7%) underwent GPD and 49 (53.3%) were submitted to PD. The frequency of GPD (62.5%) was significantly higher among patients with pancreatic neoplasia (p=0.04). The hospital stay was significantly shorter among the individuals submitted to resection due to neoplasias of less aggressive behavior (p=0.04). Surgical mortality was 10.3%, with no difference between GPD and PD. Mortality was significantly higher among individuals undergoing resection for chronic pancreatitis (p=0.001). CONCLUSION There were no differences in mortality, surgical time, bleeding or hospitalization time between GPD and PD. Pancreas head neoplasm was associated with a higher indication of GPD. Resection of less aggressive neoplasms was associated with lower morbidity and mortality.
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Affiliation(s)
| | - João Paulo Simões Dutra
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Martinho Antonio Gestic
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Murillo Pimentel Utrini
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Francisco Callejas-Neto
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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Torres OJM, Costa RCNDC, Costa FFM, Neiva RF, Suleiman TS, Souza YLMS, Shrikhande SV. MODIFIED HEIDELBERG TECHNIQUE FOR PANCREATIC ANASTOMOSIS. ACTA ACUST UNITED AC 2018; 30:260-263. [PMID: 29340550 PMCID: PMC5793144 DOI: 10.1590/0102-6720201700040008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022]
Abstract
Background: Pancreatic fistula is a major cause of morbidity and mortality after
pancreatoduodenectomy. To prevent this complication, many technical
procedures have been described. Aim: To present a novel technique based on slight modifications of the original
Heidelberg technique, as new pancreatojejunostomy technique for
reconstruction of pancreatic stump after pancreatoduodenectomy and present
initial results. Method: The technique was used for patients with soft or hard pancreas and with duct
size smaller or larger than 3 mm. The stitches are performed with 5-0 double
needle prolene at the 2 o’clock, 4 o’clock, 6 o’clock, 8 o’clock, 10
o’clock, and 12 o’clock, positions, full thickness of the parenchyma. A
running suture is performed with 4-0 single needle prolene on the posterior
and anterior aspect the pancreatic parenchyma with the jejunal seromuscular
layer. A plastic stent, 20 cm long, is inserted into the pancreatic duct and
extended into the jejunal lumen. Two previously placed hemostatic sutures on
the superior and inferior edges of the remnant pancreatic stump are passed
in the jejunal seromuscular layer and tied. Results: Seventeen patients underwent pancreatojejunostomy after
pancreatoduodenectomy for different causes. None developed grade B or C
pancreatic fistula. Biochemical leak according to the new definition
(International Study Group on Pancreatic Surgery) was observed in four
patients (23.5%). No mortality was observed. Conclusion: Early results of this technique confirm that it is simple, reliable, easy to
perform, and easy to learn. This technique is useful to reduce the incidence
of pancreatic fistula after pancreatoduodenectomy.
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Affiliation(s)
- Orlando Jorge M Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil
| | - Roberto C N da Cunha Costa
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil
| | - Felipe F Macatrão Costa
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil
| | - Romerito Fonseca Neiva
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil
| | - Tarik Soares Suleiman
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil
| | - Yglésio L Moyses S Souza
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Federal University of Maranhão, São Luiz, MA, Brazil
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Amico EC, Barreto ÉJSDS, Alves JR, João SA, Guimarães PLFC, Medeiros JACD. Fifty consecutive pancreatectomies without mortality. Rev Col Bras Cir 2016; 43:6-11. [PMID: 27096850 DOI: 10.1590/0100-69912016001003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/13/2015] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE to report the group's experience with a series of patients undergoing pancreatic resection presenting null mortality rates. METHODS we prospectively studied 50 consecutive patients undergoing pancreatic resections for peri-ampullary or pancreatic diseases. Main local complications were defined according to international criteria. In-hospital mortality was defined as death occurring in the first 90 postoperative days. RESULTS patients' age ranged between 16 and 90 years (average: 53.3). We found anemia (Hb < 12g/dl) and preoperative jaundice in 38% and 40% of cases, respectively. Most patients presented with peri-ampullary tumors (66%). The most common surgical procedure was the Kausch - Whipple operation (70%). Six patients (12%) needed to undergo resection of a segment of the mesenteric-portal axis. The mean operative time was 445.1 minutes. Twenty two patients (44%) showed no clinical complications and presented mean hospital stay of 10.3 days. The most frequent complications were pancreatic fistula (56%), delayed gastric emptying (17.1%) and bleeding (16%). CONCLUSION within the last three decades, pancreatic resection is still considered a challenge, especially outside large specialized centers. Nevertheless, even in our country (Brazil), teams seasoned in such procedure can reach low mortality rates.
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Affiliation(s)
- Enio Campos Amico
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil
| | | | - José Roberto Alves
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil
| | - Samir Assi João
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil
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Amico EC, Alves JR, João SA, Guimarães PLFC, Barreto EJSDS, Barreto LSDS, Costa PRL, Medeiros JACD. Complications after pancreatectomies: prospective study after ISGFP and ISGPS new classifications. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:213-8. [PMID: 24190380 DOI: 10.1590/s0102-67202013000300011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/24/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scientific publications focusing on the results of pancreatic resections in Brazil are scarce. AIM To present the surgical results of pancreatic resections. METHODS Were analyzed prospectively 54 consecutive cases of patients undergoing consecutive pancreatectomy evaluating the occurrence of postoperative complications (pancreatic fistula, delayed gastric emptying and postoperative hemorrhage) based on the criteria of the International Study Group on Pancreatic Fistula Definition and International Study Group of Pancreatic Surgery. RESULTS Of the 54 pancreatectomy, 32 occurred in women (59,26%) and 22 in men (40,74%). The mean age of patients was 54,5 years. The most performed procedure was the Whipple operation, in 38 patients. In eight of those cases, mesenteric-portal confluence was ressected. The mean period of hospitalization was 20,7 days. The hospitalization in 51% of patients was up to 10 days. A pancreatic fistula was observed in 50% of the cases submitted to the Whipple surgery. The postoperative hemorrhage and delayed gastric emptying in patients undergoing the surgery occurred respectively in 13,15% and 18,41%. The overall morbidity and mortality was respectively 62.9% and 5.5%. CONCLUSION There is a need for the national publications to assimilate the concepts and criteria presented by the ISGFP(2) and ISGPS(23,25) to enable comparison of the results obtained with surgical treatment of pancreatic disorders, in the Brazilian context. Who knows, therefore, whether the great advanced seen in the last 40 years in terms of the reduction in mortality rates associated with pancreatic resections may also occur with the persistently high levels of postoperative complications.
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Bonotto Orso IR, Pereira JC, D’Albuquerque LA, Cecconello I, Jukemura J. Critical analysis of the use of statistical tests in Brazilian publications related to digestive tract surgery. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Orso IRB, Pereira JC, D’Albuquerque LA, Cecconello I, Jukemura J. Critical analysis of the use of statistical tests in Brazilian publications related to digestive tract surgery. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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