Comparison of prognosis and postoperative morbidities between standard pancreaticoduodenectomy and the TRIANGLE technique for resectable pancreatic ductal adenocarcinoma

BACKGROUND

Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocarcinoma (PDAC), although tumor recurrence, especially locally, still inhibits the treatment efficacy. The TRIANGLE technique was introduced as an extended dissection procedure to improve the R0 resection rate of borderline resectable or locally advanced PDAC. However, there was a lack of studies concerning postoperative complications and long-term outcomes of this procedure on patients with resectable PDAC.

AIM

To compare the prognosis and postoperative morbidities between standard pancreaticoduodenectomy (PD) and the TRIANGLE technique for resectable PDAC.

METHODS

Patients with resectable PDAC eligible for PD from our hospital between June 2018 and December 2021 were enrolled in this retrospective cohort study. All the patients were divided into PDstandard and PDTRIANGLE groups according to the surgical procedure. Baseline characteristics, surgical data, and postoperative morbidities were recorded. All of the patients were followed up, and the date and location of tumor recurrence, and death were recorded. The Kaplan-Meier method and log-rank test were used for the survival analysis.

RESULTS

There were 93 patients included in the study and 37 underwent the TRIANGLE technique. Duration of operation was longer in the PDTRIANGLE group compared with the PDstandard group [440 (410-480) min vs 320 (265-427) min] (P = 0.001). Intraoperative blood loss [700 (500-1200) mL vs 500 (300-800) mL] (P = 0.009) and blood transfusion [975 (0-1250) mL vs 400 (0-800) mL] (P = 0.009) were higher in the PDTRIANGLE group. There was a higher incidence of surgical site infection (43.2% vs 12.5%) (P = 0.001) and postoperative diarrhea (54.1% vs 12.5%) (P = 0.001) in the PDTRIANGLE group. The rates of R0 resection and local recurrence, overall survival, and disease-free survival did not differ significantly between the two groups.

CONCLUSION

The TRIANGLE technique is safe, with acceptable postoperative morbidities compared with standardized PD, but it does not improve prognosis for patients with resectable PDAC.

Is There a Relation Between Natal Cleft Depth and Post-Operative Morbidity After Different Methods of Excision of Sacro-Coccygeal Pilonidal Sinus?

The role of natal cleft depth in postoperative morbidities after pilonidal sinus disease (PSD) surgery is still uncertain. To examine the correlation between natal cleft depth and postoperative morbidities after different methods of excision of PSD. We prospectively examined data of 66 operated patients with PSD at Prince Fahd Ben Sultan hospital, Tabouk, KSA. Of the studied patients, 18 were treated by simple closure (27.3 %), 13 patients by Bascom closure (19.7 %), 21 patients by the open method (31.8 %) and 14 patients by the semiopen method (21.2 %). Postoperative morbidities were recorded. The data were analyzed using appropriate statistical tests. Sixty six patients (62 males, 4 females) underwent surgery for PSD. The mean age of the studied patients was 26.7 ± 6.9 (range 15-51). Nine patients (13.7 %) showed delayed healing with the highest incidence was among patients treated by the open method (6/21 (28.5 %)), and 5 patients (7.5 %) showed recurrence. There have been significant positive correlations between natal cleft depth and delayed healing, which was evident among patients treated by the open method (r = +0.78; p < .0001). The findings suggest that natal cleft depth is a significant factor correlated with postoperative morbidities of PSD after surgical treatment.