Browsing by Subject "Pancreaticoduodenectomy"

Now showing 1 - 3 of 3
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    Sequential drain amylase to guide drain removal following pancreatectomy
    (Elsevier, 2018-06) Villafane-Ferriol, N.; Van Buren, G.; Mendez-Reyes, J.E.; McElhany, A.L.; Massarweh, N.N.; Silberfein, E.; Hsu, C.; Tran Cao, H.S.; Schmidt, C.; Zyromski, N.; Dillhoff, M.; Roch, A.; Oliva, E.; Smith, A.C.; Zhang, Q.; Fisher, W.E.; Surgery, School of Medicine
    BACKGROUND: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. METHODS: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. RESULTS: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. CONCLUSIONS: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.
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    The road to tailored adjuvant chemotherapy for all four non-pancreatic periampullary cancers: An international multimethod cohort study
    (Springer Nature, 2024) Uijterwijk, Bas A.; Lemmers, Daniël H.; Ghidini, Michele; Wilmink, Johanna W.; Zaniboni, Alberto; Fusai, Giuseppe Kito; Zerbi, Alessandro; Koerkamp, Bas Groot; Luyer, Misha; Ghorbani, Poya; Salvia, Roberto; White, Steven; Ielpo, Benedetto; Goh, Brian K. P.; Boggi, Ugo; Kazemier, Geert; House, Michael G.; Mavroeidis, Vasileios K.; Björnsson, Bergthor; Mazzola, Michele; Serradilla, Mario; Korkolis, Dimitris; Alseidi, Adnan; Roberts, Keith J.; Soonawalla, Zahir; Pessaux, Patrick; Fisher, William E.; Koek, Sharnice; Kent, Tara S.; Vladimirov, Miljana; Bolm, Louisa; Jamieson, Nigel; Dalla Valle, Raffaele; Kleeff, Jorg; Mazzotta, Alessandro; Suarez Muñoz, Miguel Angel; Sánchez Cabús, Santiago; Ball, Chad G.; Berger, Adam C.; Ferarri, Clarissa; Besselink, Marc G.; Hilal, Mohammed Abu; International Study Group on non-pancreatic periampullary Cancer (ISGACA); Surgery, School of Medicine
    Background: Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB. Patients and methods: Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens of adjuvant chemotherapy were compared. The primary outcome was overall survival (OS). Results: The study included a total of 2866 patients with DAC (n = 330), AmpIT (n = 765), AmpPB (n = 819), and dCCA (n = 952). Among them, 1329 received ACT, and 1537 did not. ACT was associated with significant improvement in OS for AmpPB (P = 0.004) and dCCA (P < 0.001). Moreover, for patients with dCCA, capecitabine mono ACT provided the greatest OS benefit compared to gemcitabine (P = 0.004) and gemcitabine - cisplatin (P = 0.001). For patients with AmpPB, no superior ACT regime was found (P > 0.226). ACT was not associated with improved OS for DAC and AmpIT (P = 0.113 and P = 0.445, respectively). Discussion: Patients with resected AmpPB and dCCA appear to benefit from ACT. While the optimal ACT for AmpPB remains undetermined, it appears that dCCA shows the most favourable response to capecitabine monotherapy. Tailored adjuvant treatments are essential for enhancing prognosis across all four non-pancreatic periampullary adenocarcinomas.
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    Vascular challenges from pancreatoduodenectomy in the setting of coeliac artery stenosis
    (BMJ Publishing Group, 2017-03-16) Beane, Joal D.; Schwarz, Roderich E.; Surgery, School of Medicine
    Coeliac artery stenosis due to median arcuate ligament compression or atherosclerotic disease is a frequently unrecognised challenge to recovery after pancreatoduodenectomy. The described case illustrates management with intraoperative superior mesenteric artery to hepatic artery bypass graft that led to haemorrhagic challenges postoperatively but ultimately a good recovery. Aspects of preoperative diagnosis, preoperative intervention and intraoperative management options are reviewed. Surgeons need to possess these tools to prevent complications from coeliac artery stenosis when pancreatoduodenectomy is required.