Morbidity and Mortality After Radical and Palliative Pancreatic Cancer Surgery Risk Factors Influencing the Short-Term Results

K, Bakkevold; Kambestad, Brit

doi:10.1097/00000658-199304000-00007

Cited by 157 publications

(79 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There were five randomized studies 32,33,35,36,39 that were analyzed as level 1 studies. The 18 nonrandomized studies were analyzed as level 2 studies and consisted of 11 prospective cohort studies 11,[14][15][16][22][23][24]28,30,31,37 and 5 retrospective cohort studies. [25][26][27]29,34,38,40 The mean quality score of the trials was 2.75 (standard deviation 0.5), or 55% of the best quality for trial reporting.…”

Section: Study Characteristicsmentioning

confidence: 99%

A Meta-analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice

Sewnath¹,

Karsten²,

Prins³

et al. 2002

Annals of Surgery

389

223

View full text Add to dashboard Cite

ObjectiveTo review the effectiveness of preoperative biliary drainage (PBD) in patients with obstructive jaundice resulting from tumors. Summary Background DataThis was a systematic review, including a meta-analysis, of randomized controlled trials and comparative cohort studies conducted worldwide and published between 1966 and September 2001, classified on methodologic strength and subdivided into level 1 (randomized controlled trials) and level 2 (comparative cohort studies). MethodsComparison was made of PBD versus no PBD in jaundiced patients undergoing resection of a tumor. Outcome measures were in-hospital death rate, overall complications resulting from the treatment modality (drainage-and surgery-related complications), and hospital stay. Effect sizes were calculated and combined in meta-analyses. Relative differences (%) were calculated to compare effects on outcome measures. ResultsFive randomized controlled studies comprising 302 patients met the inclusion criteria for level 1 studies, and 18 cohort studies comprising 2,853 patients met the criteria for level 2 studies. Meta-analysis of level 1 studies showed no difference in the overall death rate between patients who had PBD and those who had surgery without PBD. The overall complication rate, however, was significantly adversely affected by PBD compared with surgery without PBD. At level 2, there was no difference in the death rate between the two treatment modalities. The overall complication rate, however, was significantly adversely affected by PBD compared with surgery without PBD. If PBD had been without complications, then complications would be in favor of drainage based on level 1 studies, and no difference based on level 2 studies. Further, PBD was not able to reduce the length of postoperative hospital stay compared with surgery without PBD; instead, it prolonged the stay. ConclusionsThis meta-analysis shows that PBD with current standards for patients with obstructive jaundice resulting from tumors carries no benefit and should not be performed routinely. The potential benefit of PBD in terms of postoperative rates of death and complications does not outweigh the disadvantage of the drainage procedure. Only if PBD-related complications could be reduced by 27% and consequently diminish hospital stay could PBD be beneficial. Further randomized controlled trials with improved PBD techniques are necessary.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

A Meta-analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice

Sewnath¹,

Karsten²,

Prins³

et al. 2002

Annals of Surgery

389

223

View full text Add to dashboard Cite

show abstract

“…Medical complications evoked as a consequence of surgery include cardiac problems (angina, infarction and arrhythmias), cardiovascular accidents (strokes), cardiorespiratory distress, renal dysfunction, pneumonia, thrombosis, pulmonary embolism, psychological disturbances and hepatic and metabolic dysfunction. The extent of surgery is correlated with the rise of medical complications [43, 44]. Post-operative complications contribute to the overall mortality [40, 44]despite the experience of specialist units [43, 44].…”

Section: General Complications Following Pancreatic Resectionmentioning

confidence: 99%

“…The extent of surgery is correlated with the rise of medical complications [43, 44]. Post-operative complications contribute to the overall mortality [40, 44]despite the experience of specialist units [43, 44]. In the medium to long term there is a risk of pancreatic exocrine insufficiency and post-operative weight loss for a variety of reasons [30, 45].…”

Section: General Complications Following Pancreatic Resectionmentioning

confidence: 99%

See 1 more Smart Citation

Complications of Pancreatic Cancer Resection

et al. 2002

View full text Add to dashboard Cite

Pancreatic cancer is a common cause of cancer death in the developed world. Currently, resection is the only chance of long-term survival. The post-operative mortality in nonspecialist centres often exceeds 20% but is around 6% or less in specialist centres. The overall complication rate even in specialist centres is 18–54%. An analysis of eleven large series of pancreatic resections shows an incidence of common complications of 10.4% for fistula, 9.9% for delayed gastric emptying, 4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal abscess. The median hospital stay is 13–18 days in different series. The re-operation rate varies from 4 to 9% with a mortality rate of 23 to 67%. Major complications are a significant factor in post-operative mortality, especially if they require re-operation. The use of octreotide or somatostatin to prevent complications is supported by several multicentre, double-blind, randomized controlled trials. The best way to improve outcome is to concentrate pancreatic cancer care in regional specialist centres.

show abstract

“…In recent studies, the morbidity of palliative double bypass surgery (biliary-enteric reconstruction, gastrojejunostomy) has ranged between 4.8% and 28%, and mortality has ranged between 1% and 9% [6,7,23,24] . Nuzzo et al [12] reported that the morbidity and mortality rates for surgical palliation in elderly patients (> 70 years) with periampullary cancer were comparable to those of younger patients (≤ 70 years), with no statistically significant difference found between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Surgical palliation of unresectable pancreatic head cancer in elderly patients

Hwang¹,

Kim²,

Son³

et al. 2009

WJG

View full text Add to dashboard Cite

AIM:To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS:Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS:Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively).The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION:Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

show abstract

Morbidity and Mortality After Radical and Palliative Pancreatic Cancer Surgery Risk Factors Influencing the Short-Term Results

Cited by 157 publications

References 61 publications

A Meta-analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice

A Meta-analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice

Complications of Pancreatic Cancer Resection

Surgical palliation of unresectable pancreatic head cancer in elderly patients

Contact Info

Product

Resources

About