Long term outcomes after pancreaticodoudenectomy: a single center experience from Pakistan

Abstract

Objective: Pancreaticodoudenectomy (PD) remains a challenging surgical procedure. PD outcomes remain under reported from Pakistan. The objective of the current study was to report PD outcomes from a large single center patient cohort. Methods: A total of 155 patients who underwent PD between 2011 and 2019 were included. Outcome was assessed based on morbidity, in hospital mortality and survival. Results: Mean age was 56.8 ±13.5 years (range=8-85). Male to female ratio was (103/52)1.9:1. Overall morbidity was 84/155 (54.2%). Grade B and C pancreatic fistula (PF) were seen in 5 (3.2%) and 6 (3.8%) patients. In hospital mortality was 5/155 (3.2%). The estimated 5 year overall survival (OS) was 11% and 23% for pancreatic and non-pancreatic cancers (P=0.2). The estimated 3 year OS was lower with multivisceral resection (23% vs 5%, P <0.001), advanced tumors (40% vs 11%)(P=0.008) , nodal involvement (34% vs 12%)(P=0.04) and positive microscopic margins (30% vs 8%, P=0.006). Conclusion: Short and long term outcomes comparable to international high volume centers for PD can be achieved with site specific focus in hepatopancreatobiliary surgery. Continuous...

Acute rejection after liver transplantation with machine perfusion versus static cold storage: A systematic review and meta-analysis

“…It has been postulated by many that IRI is the root of the ACR-cascade, mediated through an early activation of the innate immune system by mitochondrial reactive oxygen species (ROS) and danger-associated molecular patterns (DAMPs) released. [5] The various dynamic preservation techniques have one common goal to provide oxygen to ischemic tissues. Currently explored dynamic liver preservation techniques include in situ techniques such as normothermic regional perfusion (NRP) performed during organ procurement from donation after cardiac death (DCD) donors and ex situ machine perfusion (MP).…”

“…This process is exacerbated by the degree of ischemia-reperfusion injury (IRI), 4 that inevitably occurs during organ preservation and transplantation. It has been postulated by many that IRI is the root of the ACR-cascade, mediated through an early activation of the innate immune system by mitochondrial reactive oxygen species (ROS) and danger-associated molecular patterns (DAMPs) released 5 …”