Browsing by Author "Nakeeb, A."

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Hepatic Steatosis After Neoadjuvant Chemotherapy for Pancreatic Cancer: Incidence and Implications for Outcomes After Pancreatoduodenectomy
    (Springer Nature, 2020-07-15) Flick, K.F.; Al-Temimi, M.H.; Maataman, T.K.; Sublette, C.M.; Swensson, J.K.; Nakeeb, A.; Ceppa, C.P.; Nguyen, T.K.; Schmidt, C.M.; Zyromski, N.J.; Tann, M.A.; House, M.G.; Surgery, School of Medicine
    Background This study aimed to determine the incidence of new onset hepatic steatosis after neoadjuvant chemotherapy for pancreatic cancer and its impact on outcomes after pancreatoduodenectomy. Methods Retrospective review identified patients who received neoadjuvant chemotherapy for pancreatic adenocarcinoma and underwent pancreatoduodenectomy from 2013 to 2018. Preoperative computed tomography scans were evaluated for the development of hepatic steatosis after neoadjuvant chemotherapy. Hypoattenuation included liver attenuation greater than or equal to 10 Hounsfield units less than tissue density of spleen on noncontrast computed tomography and greater than or equal to 20 Hounsfield units less on contrast-enhanced computed tomography. Results One hundred forty-nine patients received neoadjuvant chemotherapy for a median of 5 cycles (interquartile range (IQR), 4–6). FOLFIRINOX was the regimen in 78% of patients. Hepatic steatosis developed in 36 (24%) patients. The median time from neoadjuvant chemotherapy completion to pancreatoduodenectomy was 40 days (IQR, 29–51). Preoperative biliary stenting was performed in 126 (86%) patients. Neoadjuvant radiotherapy was delivered to 23 (15%) patients. Female gender, obesity, and prolonged exposure to chemotherapy were identified as risk factors for chemotherapy-associated hepatic steatosis. Compared with control patients without neoadjuvant chemotherapy-associated hepatic steatosis, patients developing steatosis had similar rates of postoperative pancreatic fistula (8% (control) vs. 4%, p = 0.3), delayed gastric emptying (8% vs. 14%, p = 0.4), and major morbidity (11% vs. 15%, p = 0.6). Ninety-day mortality was similar between groups (8% vs. 2%, p = 0.08). Conclusion Hepatic steatosis developed in 24% of patients who received neoadjuvant chemotherapy but was not associated with increased morbidity or mortality after pancreatoduodenectomy.
  • Thumbnail Image
    Item
    Operative treatment of portal vein aneurysm
    (Elsevier, 2022-10-13) Yedlicka, G.M.; Maatman, T.K; Mangus, R.S.; Nakeeb, A.; Surgery, School of Medicine
  • Thumbnail Image
    Item
    Routine Gastric Decompression after Pancreatoduodenectomy: Treating the Surgeon?
    (Springer, 2021) Flick, K. F.; Soufi, M.; Yip-Schneider, M. T.; Simpson, R. E.; Colgate, C. L.; Nguyen, T. K.; Ceppa, E. P.; House, M. G.; Zyromski, N. J.; Nakeeb, A.; Schmidt, C. M.; Surgery, School of Medicine
    Background The decision to routinely leave a nasogastric tube after pancreatoduodenectomy remains controversial. We sought to determine the impact of immediate nasogastric tube removal versus early nasogastric tube removal (<24 h) on postoperative outcomes. Methods A retrospective review of our institution’s prospective ACS-NSQIP database identified patients that underwent pancreatoduodenectomy from 2015 to 2018. Outcomes were compared among patients with immediate nasogastric tube removal versus early nasogastric tube removal. Results A total of 365 patients were included in primary analysis (no nasogastric tube, n = 99; nasogastric tube removed <24 h, n = 266). Thirty-day mortality and infectious, renal, cardiovascular, and pulmonary morbidity were similar in comparing those with no nasogastric tube versus early nasogastric tube removal on univariable and multivariable analyses (P > 0.05). Incidence of delayed gastric emptying (11.1 versus 13.2%) was similar between groups. Patients with no nasogastric tube less frequently required nasogastric tube reinsertion (n = 4, 4%) compared to patients with NGT <24 h (n = 39, 15%) (OR = 3.83, 95% CI [1.39-10.58]; P = 0.009). Conclusion Routine gastric decompression can be safely avoided after uneventful pancreaticoduodenectomy.