Factors Influencing Clinically Significant Delayed Gastric Emptying After Subtotal Stomach‐Preserving Pancreatoduodenectomy

Sato, Go; Ishizaki, Yoichi; Yoshimoto, Jiro; Sugo, Hiroyuki; Imamura, Hiroshi; Kawasaki, Seiji

doi:10.1007/s00268-013-2288-y

Cited by 26 publications

(29 citation statements)

References 58 publications

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“…This correlation is consistent with those found in other published series[27,28]. In a large multi-institutional study of the American College of Surgeons National Surgical Quality Improvement Program Pancreatectomy Demonstration Project, only pancreatic fistula, postoperative sepsis, and reoperation were independently associated with DGE in 711 patients undergoing PD or total pancreatectomy[27].…”

Section: Discussionsupporting

confidence: 89%

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Mohammed¹,

Buren²,

McElhany³

et al. 2017

WJGS

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AIMTo characterize incidence and risk factors for delayed gastric emptying (DGE) following pancreaticoduodenectomy and examine its implications on healthcare utilization.METHODSA prospectively-maintained database was reviewed. DGE was classified using International Study Group of Pancreatic Surgery criteria. Patients who developed DGE and those who did not were compared.RESULTSTwo hundred and seventy-six patients underwent pancreaticoduodenectomy (PD) (> 80% pylorus-preserving, antecolic-reconstruction). DGE developed in 49 patients (17.8%): 5.1% grade B, 3.6% grade C. Demographic, clinical, and operative variables were similar between patients with DGE and those without. DGE patients were more likely to present multiple complications (32.6% vs 4.4%, ≥ 3 complications, P < 0.001), including postoperative pancreatic fistula (POPF) (42.9% vs 18.9%, P = 0.001) and intra-abdominal abscess (IAA) (16.3% vs 4.0%, P = 0.012). Patients with DGE had longer hospital stay (median, 12 d vs 7 d, P < 0.001) and were more likely to require transitional care upon discharge (24.5% vs 6.6%, P < 0.001). On multivariate analysis, predictors for DGE included POPF [OR = 3.39 (1.35-8.52), P = 0.009] and IAA [OR = 1.51 (1.03-2.22), P = 0.035].CONCLUSIONAlthough DGE occurred in < 20% of patients after PD, it was associated with increased healthcare utilization. Patients with POPF and IAA were at risk for DGE. Anticipating DGE can help individualize care and allocate resources to high-risk patients.

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Section: Discussionsupporting

confidence: 89%

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Mohammed¹,

Buren²,

McElhany³

et al. 2017

WJGS

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show abstract

“…In this study, the incidence of DGE, especially grade B or C was significantly higher in the SSPPD group than in the ACPD group. The rate of DGE grade B or C in the SSPPD group was 16%, which was similar to the reported results of the SSPPD in the recent retrospective analyses [29]. Furthermore, SSPPD rather than ACPD was an independent risk factor for grade B or C DGE, and the postoperative nutritional status was comparable between the ACPD group and the SSPPD group.…”

Section: Discussionsupporting

confidence: 78%

Combined Antrectomy Reduces the Incidence of Delayed Gastric Emptying after Pancreatoduodenectomy

et al. 2017

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Background: There are a few reports that compare the rate of postoperative complications between subtotal stomach-preserving pancreatoduodenectomy (SSPPD) and antrectomy-combined pancreatoduodenectomy (ACPD), especially with respect to delayed gastric emptying (DGE) after pancreatoduodenectomy (PD). Methods: From 2002 to 2013, 628 patients who underwent SSPPD (n = 78) or ACPD (n = 550) were enrolled in this study. The rate of DGE and the nutritional status were compared between patients receiving ACPD and SSPPD. Results: The overall morbidity rate (p = 0.830) was comparable between both groups; however, the incidence of DGE grade B or C was significantly higher in the SSPPD group than that in the ACPD group (16 vs. 7%, p = 0.007). A multivariate analysis identified SSPPD rather than ACPD (p = 0.007) and portal vein resection and reconstruction (p = 0.028) to be independent risk factors for DGE grade B or C. The changes in the body weight and nutritional parameters 3, 6, and 12 months after surgery were comparable between 2 groups. Conclusions: SSPPD and not ACPD was an independent risk factor for grade B or C DGE, but the postoperative nutritional status was comparable between the 2 groups based on the limited nutritional data. Combined resection of antrum will help reduce the risk of DGE after PD.

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“…Similarly, DGE was identified as a risk factor contributing to delayed PPH. Several reports have demonstrated that a higher DGE morbidity often signified a higher incidence of PF or intra‐abdominal abscess . As such, a small pancreatic duct or postoperative DGE contributed to a higher incidence of PF or intra‐abdominal infection, which might further increase the risk of PPH.…”

Section: Discussionmentioning

confidence: 99%

Intra‐abdominal hemorrhage following 739 consecutive pancreaticoduodenectomy: Risk factors and treatments

Ding

et al. 2018

J of Gastro and Hepatol

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Background and Aim Post‐pancreaticoduodenectomy hemorrhage (PPH) is a potentially lethal complication. The objective of this study was to explore the risk factors of PPH and to evaluate the treatment options. Methods Clinical data of 739 consecutive patients undergoing pancreaticoduodenectomy between 2009 and 2017 were collected from a prospectively maintained database. Univariate and multivariate analysis was performed by logistic regression model to evaluate potential risk factors associated with early and late PPH. Results The morbidity of PPH was 8.7% (64/739), while the mortality was 12.5% (8/64). Twenty‐two (34.4%) patients developed PPH within postoperative day 1 (early PPH) whereas 42 (65.6%) patients after postoperative day 1 (late PPH). No significant risk factor was identified associated with early PPH, whereas pancreatic duct diameter < 0.4 cm, and intra‐abdominal complications, such as pancreatic fistula, intra‐abdominal abscess, and delayed gastric emptying, were independently correlated with late PPH. There were 10 (15.6%) grade A, 28 (43.8%) grade B, and 26 (40.6%) grade C bleedings. The bleeding sites were verified by endoscopy, angiography, and/or exploratory laparotomy in 23 of 54 (42.6%) patients with grade B or C hemorrhage. Seven out of nine (78%) patients with arterial bleeding were cured by angiography and embolization, while 10 of 11 (90.9%) patients with anastomotic, venous, or retroperitoneum bleeding were rescued by laparotomy. Ten patients with grade A and 22 patients with grade B or C hemorrhage were treated successfully by blood transfusion and hemostatic medications. Conclusions Hemorrhage following pancreaticoduodenectomy is a common and lethal complication. Treatment strategies should be tailored according to different etiologies.

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Factors Influencing Clinically Significant Delayed Gastric Emptying After Subtotal Stomach‐Preserving Pancreatoduodenectomy

Cited by 26 publications

References 58 publications

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Combined Antrectomy Reduces the Incidence of Delayed Gastric Emptying after Pancreatoduodenectomy

Intra‐abdominal hemorrhage following 739 consecutive pancreaticoduodenectomy: Risk factors and treatments

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