P.251 Morbidité et résultats des énucléations pancréatiques pour tumeurs endocrines

Brient, C.; Sulpice, Laurent; Mucci-Hennekine, Stéphanie; Caillard, C.; Brunaud, Laurent; Hamy, A.; Meunier, B.; Régenet, Nicolas; Mirallié, Éric

doi:10.1016/s0399-8320(09)72942-2

Cited by 1 publication

(2 citation statements)

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“…Tail resections appear to have a higher risk than central resections 17 or head resections, but are usually associated with biochemical leaks rather than clinically-relevant POPF. The risk of POPF is increased in both atypical resections and enucleations, 18,19 likely due to the increased risk of a ductal injury that is unrecognized at the time of operation, and because of a lack of anastomotic coverage over an exposed duct or branch. The largest randomized controlled trial (RCT) on stapler versus hand-sewn closure of the pancreatic remnant after distal pancreatectomy (the DISPACT trial) found no difference between the two types of closure.…”

Section: Procedure-specific Risksmentioning

confidence: 99%

“…45 The pancreatic gland Surgery in patients with pancreatic neuroendocrine tumors (PNETs) has a higher risk of POPF. 18 This is largely attributed to the fact that patients with these types of tumors more frequently undergo atypical resections and enucleations, 18,19 thus posing a different risk for ductal injury. Again, type of pathology is not modifiable and is typically associated with a number of other POPF risk factors, such as gland texture, presence of duct dilatation etc.…”

Section: Perfusion Of the Pancreatic Remnantmentioning

confidence: 99%

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Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Søreide

Healey

Mole

et al. 2019

HPB

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Background: The most hazardous complication to pancreatic surgery is the development of a postoperative pancreatic fistula (POPF). Appropriate understanding of the underlying pathophysiology, risk factors and perioperative mechanisms may allow for better management and use of preventive measures.Methods: Systematic literature search using the English PubMed literature up to April 2019, with emphasis on the past 5 years. Results: Several risk scores have been developed but none are perfect in predicting POPF risk. A conceptual framework of factors that contribute to the pathophysiology of pancreatic fistulae is still developing but incomplete. Recognized factors include those related to the patient, the pathology and the perioperative care. Interventions such as use of drains, stents and various drugs to mediate risk is still debated. Emerging data suggest that both the microbiome and the inflammation in the post-operative phase may play important roles in risk for POPF. Available risk scores allow for stratification of risk and mitigation strategies tailored to reduce this. However, accurate estimation of risk remains a challenge and mechanisms are only partially understood. Conclusions: The pathophysiology of POPF remains poorly understood. Current models only partially explain risks or associated mechanisms. Novel areas of investigation need to be explored for better prediction.

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Section: Procedure-specific Risksmentioning

confidence: 99%