Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome

Ausania, Fabio; Vallance, AE; Manas, DM; Prentis, J. J.; Snowden, Christopher; White, SA; Charnley, RM; French, J.; Jaques, BC

doi:10.1308/003588412x13373405386934

Cited by 32 publications

(28 citation statements)

References 28 publications

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“…Following screening of titles and abstracts, 25 papers were retrieved in full‐text form and assessed for eligibility. All 25 articles reported the effects of postoperative complications on long‐term survival; however, eight of these were of poor methodological quality as judged by a NOS score of 6 or less and were therefore excluded ( Tables S1 and S2 , supporting information). Poor NOS scores were due to inadequate or unreported follow‐up, lack of patient demographic information, and lack of appropriate controls for confounding factors (such as use of unadjusted univariable regression models).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival

Pucher

Aggarwal

Qurashi

et al. 2014

British Journal of Surgery

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Background: Major surgery is associated with high rates of postoperative complications, many of which are deemed preventable. It has been suggested that these complications not only present a risk to patients in the short term, but may also reduce long-term survival. The aim of this review was to examine the effects of postoperative complications on long-term survival. Methods: MEDLINE, Web of Science and reference lists of relevant articles were searched up to July 2013. Studies assessing only procedure-specific, or technical failure-related, complications were excluded, as were studies of poor methodological quality. Meta-analysis was performed using a random-effects model. Risk of bias was assessed using funnel plots. Results: Eighteen eligible studies were included, comprising results for 134 785 patients with an overall complication rate of 22⋅6 (range 10⋅6-69) per cent. The studies included operations for both benign and malignant disease. Median follow-up was 43 (range 28-96) months. Meta-analysis demonstrated reduced overall survival after any postoperative complication for ten studies with eligible data (20 755 patients), with a hazard ratio (HR) of 1⋅28 (95 per cent confidence interval 1⋅21 to 1⋅34). Similar results were found for overall survival following infectious complications: HR 1⋅92 (1⋅50 to 2⋅35). In analyses of disease-free survival the HR was 1⋅26 (1⋅10 to 1⋅42) for all postoperative complications and 1⋅55 (1⋅12 to 1⋅99) for infectious complications. Inclusion of poor-quality studies in a sensitivity analysis had no effect on the results.Conclusion: Postoperative complications have a negative effect on long-term survival. This relationship appears to be stronger for infectious complications.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival

Pucher

Aggarwal

Qurashi

et al. 2014

British Journal of Surgery

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“…13 Outcomes Table 1 shows outcomes of biliary and gastrointestinal double bypass from the literature. 4,6,7,9,10,[14][15][16][17][18][19][20][21][22] Among the 14 studies, two were prospective randomized controlled trials (RCTs) comparing double bypass and biliary bypass alone, 14,15 eight studies were retrospective comparative studies 4,7,10,[16][17][18][19][20] and the remaining were case series. 6,9,21,22 A B …”

Section: Surgical Proceduresmentioning

confidence: 99%

“…14,16,[18][19][20] Mortality rates ranged from 0% to 7%, and morbidity rates ranged from 3% to 50%. 4,6,7,9,10,[14][15][16][17][18][19][20][21][22] The morbidity rates were relatively high probably because the preoperative condition of a symptomatic patient is usually suboptimal due to medical problems caused by the disease (i.e., jaundice secondary to BO, undernourishment secondary to GOO). Furthermore, our analysis showed that prophylactic double bypass performed for unresectable pancreatic cancer patients without symptoms of BO and GOO was associated with lower morbidity rate (3%).…”

Section: Perioperative Outcomesmentioning

confidence: 99%

Surgical management of the cases with both biliary and duodenal obstruction

Miyasaka

Ohtsuka

Velasquez

et al. 2018

Int J Gastrointest Interv

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Endoscopic management is presently the recommended first-line of treatment for biliary strictures. However, surgery still has an important role especially for biliary obstruction (BO) with duodenal obstruction. Even though endoscopic treatment for concurrent BO and gastric-outlet obstruction has been proposed, it is still not widespread. Duodenal obstruction is often associated with malignant BO which makes endoscopic treatment more challenging. Biliary and gastrointestinal double bypass with Roux-en-Y hepaticojejunostomy and gastrojejunostomy is the most common surgical intervention for malignant biliary and gastric-outlet obstruction. A variety of procedures of biliary bypass and gastrointestinal bypass have been reported. According to several studies, mortality rates range from 0% to 7%, while morbidity rates range from 3% to 50%. Higher morbidity was observed in symptomatic patients caused by the disease. Most common morbidity after double bypass was delayed gastric emptying. Recurrence of BO and gastric-outlet obstruction was less frequently seen after surgical bypass compared to after endoscopic treatment. Minimally invasive approach has been applied to double bypass. Studies showed that laparoscopic double bypass has a shorter hospital stay and reduced postoperative pain; however, due to its technical demand, it is still presently an uncommon procedure. Robotic bypass surgery may resolve this issue in the future. Further analyses of outcomes of both surgical and endoscopic treatments are necessary to establish better and suitable palliation options for concurrent biliary and duodenal obstruction caused by unresectable malignant tumors.

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“…24 Hospital payments were calculated using International Classification of Diseases, 9th Revision (ICD-9), procedural and diagnosis-related group (DRG) codes. Data were extracted from Gastrojejunostomy plus hepaticojejunostomy 0.30 0.10-0.50 0.30 0.10-0.50 36,37 Gastrojejunostomy plus biliary stent 0.25 0.10-0.25 0.25 0.10-0.25…”

Section: Costsmentioning

confidence: 99%

Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

Jayakrishnan

Hasan²,

Groeschl³

et al. 2015

HPB

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Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome

Cited by 32 publications

References 28 publications

Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival

Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival

Surgical management of the cases with both biliary and duodenal obstruction

Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

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