Prognostic impact of postoperative complication after pancreatoduodenectomy for pancreatic adenocarcinoma stratified by the resectability status

Kondo, Naru; Murakami, Yoshiaki; Uemura, Kenichiro; Nakagawa, Noritoshi; Okada, Kenjiro; Takahashi, Shinya; Sueda, Taijiro

doi:10.1002/jso.25066

Cited by 9 publications

(6 citation statements)

References 21 publications

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“…Even though the most frequent reason for R1 resection is SMA margin positive in patients with PDAC, 16 those with the NCCN classification of BR or UR have worse potential for SMA margin positive compared with NCCN resectable status. 17,18 Close proximity (or direct invasion) of the tumor to the nerve plexus surrounding the SMA requires a periadventitial SMA dissection to achieve R0 resection, but a combined SMA resectionreconstruction has high operative morbidity and mortality and is not considered a typical part of PD. [19][20] Diffuse scarring of connective tissue around the SMA from chemotherapy or chemoradiation in patients with a BR or UR tumors, or the presence of preoperative cholangitis during long-term chemotherapy, can lead to an inability of the surgeon to recognize the proper tissue plane for dissection and is associated with a higher risk of unintended arterial injury.…”

Section: Discussionmentioning

confidence: 99%

“…It is understandable why an initial BR or UR status would be the strongest factor predicting the difficulty of PD. Even though the most frequent reason for R1 resection is SMA margin positive in patients with PDAC, 16 those with the NCCN classification of BR or UR have worse potential for SMA margin positive compared with NCCN resectable status 17,18 . Close proximity (or direct invasion) of the tumor to the nerve plexus surrounding the SMA requires a periadventitial SMA dissection to achieve R0 resection, but a combined SMA resection‐reconstruction has high operative morbidity and mortality and is not considered a typical part of PD 19‐20 .…”

Section: Discussionmentioning

confidence: 99%

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Estimation of the degree of surgical difficulty anticipated for pancreatoduodenectomy: Preoperative and intraoperative factors

Kosaka

Satoi

Kono

et al. 2021

J Hepato Biliary Pancreat

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Background Pancreatoduodenectomy (PD) is a technically complex procedure. Preoperative anticipation of the degree of difficulty could contribute to patient safety during trainee surgical education. Methods We prospectively administered a questionnaire to the chief surgeon after each PD performed between 2016 and 2018 at our institution (99 consecutive patients). The surgeon rated the difficulty of the procedure; we then analyzed this information against perioperative data. Results The difficulty of PD was ranked as simple (29.3%), moderate (40.4%), or difficult (30.3%). The difficult procedures required an operative time of 2 h longer than the simple procedures and involved an additional 800 mL of intraoperative blood loss. Postoperative complications were similar in all groups. Multivariate analysis revealed that an unrecognized tissue plane for dissection was an independent determinant of a difficult PD (odds ratio [OR]: 89.2, 95% confidence interval [CI]: 9.2‐861.2; P < .001). Independent predictors of a difficult PD were a pretreatment status of borderline resectable or unresectable (OR: 21.9, CI: 5.3‐90.6; P < .001) and cholangitis during the preoperative period (OR: 4.1, CI: 1.3‐13.0; P = .017). Conclusions Surgeons deem the PD procedure to be difficult when the proper tissue plane for dissection is unrecognized. Preoperative assessment of the anticipated difficulty could contribute to better operative management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Estimation of the degree of surgical difficulty anticipated for pancreatoduodenectomy: Preoperative and intraoperative factors

Kosaka

Satoi

Kono

et al. 2021

J Hepato Biliary Pancreat

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“…In some high-volume centers, mortality of surgical strategy was much lower than reported. Furthermore, long-term and short-term morbidity of pancreatic surgery remained high with PF, DGE, diabetes mellitus and/or exocrine pancreatic insufficiency (11,(19)(20)(21). Therefore, all treatment options should be carefully considered.…”

Section: Discussionmentioning

confidence: 99%

Surveillance and management for serous cystic neoplasms of the pancreas based on total hazards—a multi-center retrospective study from China

et al. 2019

Ann Transl Med

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Background: Serous cystic neoplasms (SCN) rarely have malignant potential, so accurate diagnosis of SCN is crucial for proper clinical management, especially to avoid unnecessary surgeries. However, the misdiagnosis of other pancreatic cystic neoplasm instead of SCN may highly increase the risk of malignancy in patients who receive no surgery.Methods: Data from a total of 678 patients with pathologically confirmed to have SCN at sixteen institutions in China from January 1 st , 2006 to December 31 st , 2016 were retrieved to evaluate the malignancy risk of SCN.Results: Among the 678 patients confirmed to have SCN with postoperative pathologic analysis, 649 patients (95.7%) had only one lesion and the average maximum diameter was 3.8±2.47 cm. Four patients were pathologically verified as having serous cystadenocarcinoma, so the SCN actual malignancy rate was 0.6%, while the mortality due to pancreatic surgery in these high-volume centers was nearly 0.2-2%. However, among the 99 SCN patients based on preoperative radiology, three were confirmed to have intraductal papillary mucinous Wu et al. Surveillance and management for SCN of the pancreas

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“…The quality of digestive reconstructions, including the reconstruction of hepaticojejunostomy, pancreatojejunostomy, and gastrointestinal anastomosis (GA), are vital factors that contribute to surgical success [ 4 ], and are closely related to postoperative complications that have recently been reported as prognostic factors [ 5 6 7 ]. The principal methods of digestive reconstruction comprise hand-sewn anastomosis (HA) and stapled anastomosis (SA).…”

Section: Introductionmentioning

confidence: 99%

A reinforced suture method for stapled gastrointestinal anastomosis to reduce gastrointestinal hemorrhage during Whipple operation in laparoscopy

Jiang

et al. 2022

Ann Surg Treat Res

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Purpose Laparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high. Methods One hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods. Results Of the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001). Conclusion Our retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.

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Prognostic impact of postoperative complication after pancreatoduodenectomy for pancreatic adenocarcinoma stratified by the resectability status

Abstract: A negative prognostic impact of postoperative major complications after PD was observed in patients with BR/UR PDAC, whereas the prognostic impact was unclear in patients with R PDAC.

Cited by 9 publications

References 21 publications

Estimation of the degree of surgical difficulty anticipated for pancreatoduodenectomy: Preoperative and intraoperative factors

Estimation of the degree of surgical difficulty anticipated for pancreatoduodenectomy: Preoperative and intraoperative factors

Surveillance and management for serous cystic neoplasms of the pancreas based on total hazards—a multi-center retrospective study from China

A reinforced suture method for stapled gastrointestinal anastomosis to reduce gastrointestinal hemorrhage during Whipple operation in laparoscopy

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