Reoperative Completion Pancreatectomy for Suspected Malignant Disease of the Pancreas

Emergency pancreatic surgery—demanding and dangerous

“…This is attributed not only to surgical expertise but also to improved perioperative anesthesiological care and interventional radiologic complication management. Emergency pancreatic resections have been mainly published with regard to postoperative damage control after preceding pancreatic resections, e.g., as remnant pancreatectomy after Whipple procedures in patients suffering from complicated POPF [2][3][4][5]. These publications have shown that salvage resections are associated with increased morbidity and mortality compared to elective procedures.…”

“…In the present study, radiological interventions included abdominal drain placement, angiographic bleeding control, and percutaneous stenting of the bile duct in case of leakage to avoid re-operation in a critical condition of the patient which would represent a re-emergency surgical approach [22,23,26]. Despite this, a re-operation was necessary in one third of the patients which is obviously higher than the 5-10 % rate of re-operations following elective pancreas resections [2][3][4]. Ongoing abdominal sepsis, diffuse bleeding, and ischemic complications of the large bowel, as observed in other critically ill patients, too [28], led to the high re-operation rate.…”

“…In contrast to the elective setting, pancreatic resections in emergency situations are mainly performed as postoperative salvage procedures, e.g., completion pancreatectomy to control fistula-associated complications after partial duodeno-pancreatectomy [2][3][4][5]. The topic of primary emergency pancreatic resection without preceding operative procedures has been scarcely investigated.…”

Aggressive secondary surgery for local recurrence of pancreatic cancer

“…While surgical resection is the only potential curative therapy, recurrence occurs in as high as 80% of the patients and the high incidence of recurrence is a cause of the poor prognosis 1 2. Although local recurrence without distant metastases is not a rare situation, there are no standardised treatments and the majority of these patients are treated with palliative chemotherapy or chemoradiotherapy alone 3.…”

Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection.

“…Only anecdotal experiences and small case series have been previously published, and these series reported outcomes of patients diagnosed with a variety of periampullary neoplasms or those with recurrence limited to certain anatomic sites. [17][18][19][20] We sought to gain a more comprehensive understanding of the outcomes of individuals with isolated recurrent PDAC treated with potentially curative reoperation and hypothesized that reoperation may be appropriate for selected patients with recurrent PDAC. To characterize these patients, we retrospectively evaluated the outcomes of all patients diagnosed at our institution with recurrent PDAC who underwent reoperation with curative intent over an 18-year period.…”