Pancreaticoduodenectomy in a tertiary referral center in Saudi Arabia: A retrospective case series

Aziz, Amr Mostafa; Abbas, Ahmad; Gad, Hisham; Al-Saif, Osama; Leung, Kam Fung; Meshikhes, Abdul-Wahed Nasir

doi:10.1016/j.jnci.2011.12.007

Cited by 4 publications

(3 citation statements)

References 41 publications

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“…A second paper[14] from the same institution and overlapping the same time period[11] described the presentation, characteristics, and the perioperative complications of patients who underwent a pancreatoduodenectomy for both benign and malignant conditions but only included 14 cases with pancreatic cancer. The largest cohort reported from the region to date is from AlGhamdi et al .,[3] which included 179 patients with pancreatic tumors over a 10-year period; 132 of those had adenocarcinomas.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of resectability of pancreatic adenocarcinoma

Almadi

Alharbi

Azzam

et al. 2013

Saudi J Gastroenterol

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Background/Aims:Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery.Materials and Methods:A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients’ demographic information (age, gender), height, weight, body mass index, historical data (smoking, comorbidities), symptoms (abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color), jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor.Results:A total of 61 patients were included, the mean age was 61.2 ± 1.51 years, 25 (41%) were females. The tumors were located in the head (83.6%), body (10.9%), tail (1.8%), and in multiple locations (3.6%) of the pancreas. Half of the patients (50%) had Stage IV, 16.7% stages IIB and III, and only 8.3% were stages IB and IIA. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 (95% confidence interval, 0.42-0.98), whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma.Conclusion:This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

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Section: Discussionmentioning

confidence: 99%

Clinical predictors of resectability of pancreatic adenocarcinoma

Almadi

Alharbi

Azzam

et al. 2013

Saudi J Gastroenterol

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“…In a larger volume study conducted by Andreas Minh Luu et al, 17.3% of the 722 patients experienced POPF, with 2.8% having biochemical leaks, 11.4% having grade B leaks, and 3.2% having grade C leaks [40]. Another low-volume study by Amr Mostafa Aziz et al evaluated 32 patients who underwent PD, with pancreatic leaks occurring in 15.6% of cases [43] . In our study, patients with POPF experienced varying morbidity outcomes.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Pancreatic Fistula After Pancreaticoduodenectomy

Al-Shehari,

Obadiel,

Bafalia

et al. 2023

jchm

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Background: The occurrence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a major contributor to morbidity and mortality. Hence, it is imperative to decrease the occurrence of clinically significant POPF to enhance the overall morbidity outcomes associated with PD. This study seeks to assess the outcomes of pancreatic fistula following PD. Methods: This study was a combined prospective and retrospective analysis of patients who underwent PD at Al-Thawra Modern General Hospital between January 2016 and April 2021. A total of 42 patients were included in the analysis. Results: Among the 42 patients who underwent PD, 40% were male and 60% were female. The age distribution showed that 5% of patients were under 20, 14% were between 20 and 40, and 81% were above 40. The primary indications for PD were malignant periampullary tumors in 83.3% of patients, solid pseudopapillary tumors of the pancreas in 7.1% of patients, chronic pancreatitis in 4.76% of patients, duodenal adenocarcinoma in 2.38% of patients, and trauma in 2.38% of patients. Among the patients, 30 (71.43%) had a successful recovery without evidence of pancreatic fistula (PF), whereas 12 (28.57%) developed POPF. Among the 12 patients with POPF, 3 (7.14%) had a biochemical leak, 5 (11.9%) had a grade B fistula, and 4 (9.53%) had a grade C fistula according to the revised ISGPS definition. Of the patients with POPF, those with a biochemical leak did not experience significant morbidity and were managed conservatively. Patients with grade B fistula (5 patients) had an extended hospital stay of approximately 2-3 weeks and received percutaneous drainage as an intervention. One patient (8.33%) with grade C fistula required reoperation because of bleeding, and 3 patients (25%) developed septic shock and subsequently died, resulting in an overall mortality rate of 25% among patients with POPF. Conclusion: POPF following PD remains a serious complication of substantial morbidity and mortality. Further improvements in the prevention, early detection, and management of POPF are necessary to reduce postoperative morbidity and mortality. Using the ISGPS definition and grading of PF aids in the clinical assessment and management of PF.

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“…PD is a complex procedure with high mortality and morbidity. In South Korea, the morbidity and mortality rates of this procedure were reported to be 10.9%–53% and 0%–2.6%, respectively, [ 5 6 7 ] while those of other countries were 20%–53% and 1.1%–4.3%, respectively, with no statistical difference respectively, showing no statistical difference [ 8 9 10 11 12 ]. Although the mortality rate was relatively constant at lower than 5%, the postoperative complication rate showed a wide range, which might be due to different institutional definitions [ 13 14 15 ].…”

Section: Discussionmentioning

confidence: 99%

The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital

et al. 2017

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PurposePancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD.MethodsFrom March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status.ResultsThe percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6–137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%.ConclusionPerforming PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.

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Pancreaticoduodenectomy in a tertiary referral center in Saudi Arabia: A retrospective case series

Cited by 4 publications

References 41 publications

Clinical predictors of resectability of pancreatic adenocarcinoma

Clinical predictors of resectability of pancreatic adenocarcinoma

Outcomes of Pancreatic Fistula After Pancreaticoduodenectomy

The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital

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