Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis

Kokkinakis, Stamatios; Kritsotakis, Evangelos I.; Maliotis, Neofytos; Karageorgiou, Ioannis; Chrysos, Emmanuel; Lasithiotakis, Konstantinos

doi:10.1016/j.hbpd.2022.04.006

Cited by 19 publications

(7 citation statements)

References 107 publications

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“…With the constant update of surgeons’ knowledge and advancements in surgical techniques, the safety of surgery has greatly improved, and the mortality rate associated with the surgery has gradually reduced, with a reported mortality rate of < 6% [ 4 ]; moreover, the scope of application has gradually widened. However, the postoperative complications of PD include postoperative pancreatic fistula, biliary fistula, hemorrhage, abdominal infection, delayed gastric emptying after surgery, and venous thrombosis [ 5 ], which lead to longer hospitalization days and higher hospitalization costs, thereby delaying patients’ recovery and increasing their financial burden.…”

Section: Introductionmentioning

confidence: 99%

Risk factor analysis and a new prediction model of venous thromboembolism after pancreaticoduodenectomy

2023

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Aim The present study aimed to identify risk factors for venous thromboembolism (VTE) after pancreaticoduodenectomy (PD) and to develop and internally validate a predictive model for the risk of venous thrombosis. Methods We retrospectively collected data from 352 patients who visited our hospital to undergo PD from January 2018 to March 2022. The number of patients recruited was divided in an 8:2 ratio by using the random split method, with 80% of the patients serving as the training set and 20% as the validation set. The least absolute shrinkage and selection operator (Lasso) regression model was used to optimize feature selection for the VTE risk model. Multivariate logistic regression analysis was used to construct a prediction model by incorporating the features selected in the Lasso model. C-index, receiver operating characteristic curve, calibration plot, and decision curve were used to assess the accuracy of the model, to calibrate the model, and to determine the clinical usefulness of the model. Finally, we evaluated the prediction model for internal validation. Results The predictors included in the prediction nomogram were sex, age, gastrointestinal symptoms, hypertension, diabetes, operative method, intraoperative bleeding, blood transfusion, neutrophil count, prothrombin time (PT), activated partial thromboplastin time (APTT), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT), and total bilirubin (TBIL). The model showed good discrimination with a C-index of 0.827, had good consistency based on the calibration curve, and had an area under the ROC curve value of 0.822 (P < 0.001, 95%confidence interval:0.761–0.882). A high C-index value of 0.894 was reached in internal validation. Decision curve analysis showed that the VTE nomogram was clinically useful when intervention was decided at the VTE possibility threshold of 10%. Conclusion The novel model developed in this study is highly targeted and enables personalized assessment of VTE occurrence in patients who undergo PD. The predictors are easily accessible and facilitate the assessment of patients by clinical practitioners.

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Section: Introductionmentioning

confidence: 99%

Risk factor analysis and a new prediction model of venous thromboembolism after pancreaticoduodenectomy

2023

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“…POPF and anastomotic leaks are the primary clinically significant complications after PD and colectomies, respectively. The clinically relevant POPF rates after PD vary between 10.9% and 22.4% [1,4,5,7,75]; POPF represents the most common source of surgical mortality after PD. Nationwide population studies showed anastomotic leak rates after colectomies of 6.2% to 7% [76,77].…”

Section: Complications Of Pd With Concurrent Colectomiesmentioning

confidence: 99%

Pancreaticoduodenectomies with Concurrent Colectomies: Indications, Technical Issues, Complications, and Oncological Outcomes

Dumitrascu

2023

JCM

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Multi-visceral resections for colon and pancreatic cancer (PDAC) are feasible, safe, and justified for early and late outcomes. However, the use of pancreaticoduodenectomy (PD) with concurrent colectomies is highly debatable in terms of morbidity and oncological benefits. Based on current literature data, this review assesses the early and long-term outcomes of PD with colectomies. The association represents a challenging but feasible option for a few patients with PDAC or locally advanced right colon cancer when negative resection margins are anticipated because long-term survival can be achieved. Concurrent colectomies during PD should be cautiously approached because they may significantly increase complication rates, including severe ones. Thus, patients should be fit enough to overcome potential severe complications. Patients with PD and colectomies can be classified as borderline resectable, considering the high risk of developing postoperative complications. Carefully selecting patients suitable for PD with concurrent colectomies is paramount to mitigate the potentially severe complications of the two surgical procedures and maximize the oncological benefits. These procedures should be performed at high-volume centers with extensive experience in pancreatectomies and colectomies, and each patient situation should be assessed using a multimodal approach, including high-quality imaging and neoadjuvant therapies, in a multidisciplinary team discussion.

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“…It is considered one of the most complex procedures in general surgery and one of the most difficult to break through in minimally invasive surgery because of the complex anatomy involved, difficulty of the operation, and high rate of postoperative complications. 1,2 Furthermore, the survival of pancreatic cancer patients after surgery is affected by several factors, such as the rate of surgical resection, extent of surgical resection, clearance of the peripancreatic plexus, and postoperative complications. 3 Laparoscopic PD (LPD) offers several advantages, such as reducing tissue damage, lowering postoperative inflammatory responses, minimising disruption to the patient's physiological state, and decreasing the incidence of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

“…Pancreaticoduodenectomy (PD) is an important procedure for treating benign and malignant tumours of the pancreatic head. It is considered one of the most complex procedures in general surgery and one of the most difficult to break through in minimally invasive surgery because of the complex anatomy involved, difficulty of the operation, and high rate of postoperative complications 1,2 . Furthermore, the survival of pancreatic cancer patients after surgery is affected by several factors, such as the rate of surgical resection, extent of surgical resection, clearance of the peripancreatic plexus, and postoperative complications 3 .…”

Section: Introductionmentioning

confidence: 99%

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical‐site wound infection: A meta‐analysis

Kong

Zhang

Zhao

et al. 2023

International Wound Journal

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A meta‐analysis was conducted to assess the impact of robotic and laparoscopic pancreaticoduodenectomies on postoperative surgical site wound infections. A comprehensive computerised search of databases, such as PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data, was performed to identify studies comparing robotic pancreaticoduodenectomy (PD) with laparoscopicPD. Relevant studies were searched from the inception of the database construction until April 2023. The meta‐analysis outcomes were analysed using odds ratios (OR) with corresponding 95% confidence intervals (CI). The RevMan 5.4 software was used for the meta‐analysis. The findings of the meta‐analysis showed that patients who underwent laparoscopic PD had a significantly lower incidence of surgical‐site wound (16.52% vs. 18.92%, OR: 0.78, 95% CI: 0.68–0.90, P = .0005), superficial wound (3.65% vs. 7.57%, OR: 0.51, 95% CI: 0.39–0.68, P < .001), and deep wound infections (1.09% vs. 2.23%, OR: 0.53, 95% CI: 0.34–0.85, P = .008) than those who received robotic PD. However, because of variations in sample size between studies, some studies suffered from methodological quality deficiencies. Therefore, further validation of this result is needed in future studies with higher quality and larger sample sizes.

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Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis

Cited by 19 publications

References 107 publications

Risk factor analysis and a new prediction model of venous thromboembolism after pancreaticoduodenectomy

Risk factor analysis and a new prediction model of venous thromboembolism after pancreaticoduodenectomy

Pancreaticoduodenectomies with Concurrent Colectomies: Indications, Technical Issues, Complications, and Oncological Outcomes

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical‐site wound infection: A meta‐analysis

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