Delayed Gastric Emptying After Pancreaticoduodenectomy: an Analysis of Risk Factors and Cost

Eisenberg, Joshua D.; Rosato, Ernest L.; Lavu, Harish; Yeo, Charles J.; Winter, Jordan M.

doi:10.1007/s11605-015-2865-5

Cited by 88 publications

(73 citation statements)

References 45 publications

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“…Delayed gastric emptying most commonly occurs in the presence of other intra-abdominal complications, such as pancreatic leak or intra-abdominal abscess (secondary DGE). [17][18][19][20][21] Delayed gastric emptying can also occur in the absence of other intraabdominal complications (primary DGE). It has been hypothesized that pyloric denervation, lack of motilin from duodenectomy, loss of pyloric pump, gastric dysrhythmia, and inflammation may be underlying contributing mechanisms for DGE.…”

mentioning

confidence: 99%

“…18,[22][23][24] Patient-related factors such as male sex, smoking history, and estimated blood loss have been shown to be associated with increased incidence of DGE. 19 Currently, there are no modifiable procedure-related factors that have been shown to be associated with decreased or increased incidence of DGE after PD. It has been reported that some configurations of the gastrojejunal (GJ) anastomosis may interfere with food passage.…”

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confidence: 99%

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Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy

et al. 2018

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confidence: 99%

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confidence: 99%

Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy

et al. 2018

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“…In a recent study by Okano et al (17), both variables were independently associated with infectious complications. Previous studies showed male gender to be related to specific complications, such as surgical site infection, pancreatic fistula and delayed gastric emptying (17)(18)(19). Recent studies have shown visceral fat as a predictor for pancreatic fistula and postoperative mortality (20,21).…”

Section: Discussionmentioning

confidence: 99%

Advanced age does not increase morbidity in pancreaticoduodenectomy

Namur¹,

Dantas²,

Jureidini³

et al. 2018

J. Gastrointest. Oncol.

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Background: Due to rising life expectancy of population, very complex surgical procedures such as pancreaticoduodenectomy (PD), are more commonly being performed in elderly patients. The objective of this study was to evaluate the safety of PD in patients older than 75 years old and the risk factors associated with severe complications.Methods: Patients who underwent PD for periampullary tumors were retrospectively reviewed and divided into two groups, A (<75 years) and B (>75 years). The primary endpoint was severe postoperative complications (Clavien 3 or greater). Secondary endpoints were mortality and any complications.Results: Ninety consecutive patients underwent PD for periampullary tumors in the studied period, 70 in group A and 20 in group B. Clinical and pathological characteristics of both groups were equivalents except for age. There were no difference regarding the incidence of severe complications (17% vs. 10%, P=0.72) or all complications (50% vs. 50%, P>0.999). Although mortality was greater in group A (8.6% vs. 0%), it was not statistically significant (P=0.333). On multivariate analyses, only male sex, obesity and American Society of Anesthesiology Score of 3 or 4 were associated with severe postoperative complications. Conclusions:Poor clinical status, obesity and male gender are associated with severe complications in PD, but not age greater than 75 years, therefore PD can be considered safe in elderly patients and age itself should not be a contraindication for PD.

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“…22,23 Postoperative nausea/vomiting from delayed gastric emptying (DGE) is common; mean incidences range from 17% to 24%. 20,24,25 Pancreatic fistulas occur in 10% to 20% of cases; although the majority are clinically insignificant, inadequate management can lead to sepsis and hemorrhage, with 20% to 40% mortality. 20,[26][27][28] Sepsis rates may be around 9% to 16% 29,30 ; overall infection rates are difficult to ascertain, but are at least 17% to 20%.…”

Section: Complications After Surgery Alonementioning

confidence: 99%

Neoadjuvant Therapy for Pancreatic Cancer

Verma

Lin

2016

American Journal of Clinical Oncology

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The purpose of this review was to assess whether neoadjuvant chemotherapy and chemoradiotherapy (CRT) result in differential postoperative morbidity and mortality as compared with pancreatic tumor resection surgery alone. Using PRISMA guidelines and the PubMed search engine, we reviewed all prospective phase II trials of neoadjuvant chemotherapy and CRT for pancreatic cancer that examined postoperative morbidities and mortalities. A total of 30 articles were identified, collated, and analyzed. Risks of postoperative complications vary based on trial. With surgery alone, the most common postoperative complications included delayed gastric emptying (DGE) (17% to 24%), pancreatic fistula (10% to 20%), anastomotic leaks (0% to 15%), postoperative bleeding (2% to 13%), and infections/sepsis (17% to 20%). With surgery alone, the mortality was <5%. Neoadjuvant chemotherapy showed comparable fistula rates (3% to 4%), leaks (3% to 11%), infection (3% to 7%), with mortality 0% to 4% in all but 1 study. CRT for resectable/borderline resectable patients also showed comparable complication rates: DGE (6% to 15%), fistulas (2% to 3%), leaks (3% to 7%), bleeding/hemorrhage (2% to 13%), infections/sepsis (3% to 19%), with 9/13 studies showing a mortality of ≤4%. As compared with initially borderline/resectable tumors, CRT for initially unresectable tumors (despite less data) showed higher complication rates: DGE (13% to 33%), fistulas (3% to 25%), infections/sepsis (3% to 16%). However, the confounding factor of the potentially higher tumor burden as an associative agent remains. The only parameters slightly higher than historical surgery-only complication rates were leaks and bleeding/hemorrhage (13% to 20%). Mortality rates in these patients were consistently 0%, with 2 outliers. Hence, neoadjuvant chemotherapy/CRT is safe from a postoperative complication standpoint, without significant increases in complication rates compared with surgery alone. Resectable and borderline resectable patients have fewer complications as compared with unresectable patients, although data for the latter are lacking.

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Delayed Gastric Emptying After Pancreaticoduodenectomy: an Analysis of Risk Factors and Cost

Abstract: DGE is common after PD and contributes substantially to cost. DGE is frequently a secondary complication of abdominal infection, and interventions that limit such complications may be the most effective strategy toward preventing DGE.

Cited by 88 publications

References 45 publications

Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy

Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy

Advanced age does not increase morbidity in pancreaticoduodenectomy

Neoadjuvant Therapy for Pancreatic Cancer

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