Computed tomography after radical pancreaticoduodenectomy (Whipple's procedure)

Smith, Simon; Hampson, F.; Duxbury, Mark; Rae, D M; Sinclair, MT

doi:10.1016/j.crad.2007.10.012

Cited by 21 publications

(18 citation statements)

References 17 publications

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“…Elderly pancreatic cancer patients who undergo the Whipple resection have higher rates of postoperative complications such as delayed gastric emptying, pancreaticojejunal leak, sepsis, biliary leak, gastrointestinal tract bleeding, and intra-abdominal hemorrhage [17]. One study found that among patients who underwent pancreaticoduodenectomy, octogenarians had a mortality rate of 4.1% and a complication rate of 52.8% whereas these rates were 1.7% and 41.6%, respectively for younger patients [18].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients

et al. 2013

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BackgroundTreatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.MethodsA retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007–2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).ResultsThe median age was 86 (range 80–91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.ConclusionsDefinitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients

et al. 2013

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“…When the patient is hemodynamically stable, it's generally recommended to perform abdominal and pelvic multidetector computer tomography (MDCT) angiography as soon as sentinel bleeding is observed, when sensitivity is highest (12,22,29,37,38). MDCT angiography can show the cause, nature and site of bleeding, being a fundamental tool as it can avoid or guide treatment (10,15,(39)(40)(41). Nonetheless, even if MDCT is performed, a clear bleeding site cannot be identified in many cases (1).…”

Section: Clinical Manifestation Diagnosis and Managementmentioning

confidence: 99%

Bleeding complications after pancreatic surgery: interventional radiology management

2019

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Surgical intervention in the pancreas region is complex and carries the risk of complications, also of vascular nature. Bleeding after pancreatic surgery is rare but characterized by high mortality. This review reports epidemiology, classification, diagnosis and treatment strategies of hemorrhage occurring after pancreatic surgery, focusing on the techniques, roles and outcomes of interventional radiology (IR) in this setting. We then describe the roles and techniques of IR in the treatment of other less common types of vascular complications after pancreatic surgery, such as portal vein (PV) stenosis, portal hypertension and bleeding of varices.

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“…However, in the setting of PD surgery, most centres—including ours—discourage the use of oral CM, since it may cause beam-hardening artefacts and hamper detection of haemorrhage. Furthermore, recently operated patients are often unwell and not willing or able to swallow, particularly those with a distended stomach secondary to DGE [ 9 – 11 ].…”

Section: Early Post-pancreatico-duodenectomy Ctmentioning

confidence: 99%

“…Unfortunately, interpretation of early postoperative CT imaging is generally challenging due to the surgically altered anatomy. Aiming to improve radiologists’ familiarity with postsurgical abdominal studies, this pictorial essay reviews and illustrates the expected postoperative CT appearances and the imaging features of typical and unusual post-PD complications [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Elucidating early CT after pancreatico-duodenectomy: a primer for radiologists

Tonolini

Ierardi²,

Carrafiello³

2018

Insights Imaging

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Pancreatico-duodenectomy (PD) represents the standard surgical treatment for resectable malignancies of the pancreatic head, distal common bile duct, periampullary region and duodenum, and is also performed to manage selected benign tumours and refractory chronic pancreatitis. Despite improved surgical techniques and acceptable mortality, PD remains a technically demanding, high-risk operation burdened with high morbidity (complication rates 40–50% of patients). Multidetector computed tomography (CT) represents the mainstay modality to rapidly investigate the postoperative abdomen, and to provide a consistent basis for an appropriate choice between conservative, interventional or surgical treatment. However, radiologists require familiarity with the surgically altered anatomy, awareness of expected imaging appearances and possible complications to correctly interpret early post-PD CT studies. This paper provides an overview of surgical indications and techniques, discusses risk factors and clinical manifestations of the usual postsurgical complications, and suggests appropriate techniques and indications for early postoperative CT imaging. Afterwards, the usual, normal early post-PD CT findings are presented, including transient fluid, pneumobilia, delayed gastric emptying, identification of pancreatic gland remnant and of surgical anastomoses. Finally, several imaging examples review the most common and some unusual complications such as pancreatic fistula, bile leaks, abscesses, intraluminal and extraluminal haemorrhage, and acute pancreatitis.Teaching Points • Pancreatico-duodenectomy (PD) is a technically demanding surgery burdened with high morbidity (40–50%). • Multidetector CT is the mainstay technique to investigate suspected complications following PD. • Interpreting post-PD CT requires knowledge of surgically altered anatomy and expected findings. • CT showing collection at surgical site supports clinico-biological diagnosis of pancreatic fistula. • Other complications include biliary leaks, haemorrhage, abscesses and venous thrombosis.

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Computed tomography after radical pancreaticoduodenectomy (Whipple's procedure)

Cited by 21 publications

References 17 publications

Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients

Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients

Bleeding complications after pancreatic surgery: interventional radiology management

Elucidating early CT after pancreatico-duodenectomy: a primer for radiologists

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