SURGICAL AND ONCOLOGICAL OUTCOMES OF PANCREATICODUODENECTOMY– SINGLE INSTITUTIONAL RETROSPECTIVE ANALYSIS

Dr. C. Srinivas, Dr.Pavan Kumar J, Dr. Karthik, Dr. C. Ramachandra

Abstract


Background: Whipple’s pancreaticoduodenectomy (PD) described in 1945 had mortality of 38%. With advances in surgical management of PD, mortality rate for PD has been reported to be less than 5%. Postoperative pancreatic fistula (POPF) remains a major complication and morbidity after PD with incidence upto 40%.

Materials and Methods: This is a retrospective analyses of patients who underwent PD from a tertiary cancer center in southern India from Jan 2013 to Dec 2017. Preoperative, intraoperative, postoperative details and surgico-oncological outcomes are presented.

Results: Of 76 patients presumed as operable periampullary cancers, 16 were declared inoperable and data analyzed for remaining 60 patients. 44% underwent classical Whipple’s PD and 56% pylorus preserving PD. Duct to mucosa pancreaticojejunostomy was performed in all patients. Mean operative time, blood loss and hospital stay was 293±68.6min,695±300ml and 13±6days; 8% developed grade A delayed gastric emptying(DGE); POPF Grade B in 5%. Wound infection(25%) and pneumonia(15%) are common postop complications; Five patients (8%) had biliary fistula; 30 day in-hospital-mortality was 1.6%; 60% had periampullary tumours; Median survival was 22 months (Range7-76 months); 10% developed liver metastasis on follow up.

Conclusions: Pancreaticoduodenectomy is a safe operation in experienced hands. Surgical results from our center is comparable to the literature published from centers of excellence.


Keywords


Pancreaticoduodenectomy, whipple’s operation, POPF

Full Text:

PDF

References


Whipple AO: Pancreaticoduodenectomy for Islet Carcinoma : A Five-Year Follow-Up. Ann Surg. 1945 121:847-852.

Shrikhande SV, Barreto G, Shukla PJ. Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy. Langenbecks Arch Surg. 2008;393:87-91.

Yamashita Y, Yoshizumi T, Fukuzawa K, etal. Surgical Results of Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: a Multi-institutional Retrospective Study of 174 patients.

. Anticancer Res. 2016;36:2407-12.

Z’graggen K, Uhl W, Friess H, etal. How to do a safe pancreatic anastomosis. J Hepatobiliary Pancreat Surg 2002;9:733 7.

Shrikhande SV, Kleeff J, Büchler MW, et al. Pancreatic anastomosis after pancreaticoduodenectomy: how we do it. Indian J Surg. 2007;69:224-9.

Bassi C, Marchegiani G, Dervenis C, etal. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017;161:584 91.

Wente MN, Bassi C, Dervenis C, etal. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761-8.

Wente MN, Veit JA, Bassi C, etal. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20-5.

Kay AW. Reflections of Sir Andrew Watt Kay. Contemp. Surg. 1978;13:71.

Schnelldorfer T, Adams DB, Warshaw AL, etal. Forgotten pioneers of pancreatic surgery: beyond the favorite few. Ann Surg. 2008; 247:191-202.

Whipple AO, Parsons WB, Mullins CR. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg. 1935;102:763-79.

WHIPPLE AO. Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet. 1946;82:623-31.

Cameron JL, Pitt HA, Yeo CJ, etal. One-hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430-438.

Ji W, Shao Z, Zheng K, etal. Pancreaticojejunostomy with double-layer continuous suturing is associated with a lower risk of pancreatic fistula after pancreaticoduodenectomy: a comparative study. Int J Surg. 2015;13:84-89.

C. Bassi, G. Butturini, E. Molinari, etal. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg. 2004;21:54-9.

Barreto SG, Shukla PJ. Different types of pancreatico-enteric anastomosis. Transl Gastroenterol Hepatol. 2017 Nov 14;2:89. .

Torres OJM, Costa RCNDC, Costa FFM, etal. MODIFIED HEIDELBERG TECHNIQUE FOR PANCREATIC ANASTOMOSIS. Arq Bras Cir Dig. 2017;30:260-263.

Ecker BL, McMillan MT, Asbun HJ, etal. Characterization and Optimal Management of High- risk Pancreatic Anastomoses During Pancreatoduodenectomy. Ann Surg. 2018;267:608-616.

Shrikhande SV, Sivasanker M, Vollmer CM, etal. Pancreatic anastomosis after pancreatoduodenectomy: A position statement by International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2017;161:1221-1234.

Lin JW, Cameron JL, Yeo CJ, etal. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg. 2004;8:951-9.

Hanna MM, Gadde R, Allen CJ, etal. Delayed gastric emptying after pancreaticoduodenectomy. J Surg Res. 2016;202:380-8.

El Nakeeb A, Askr W, Mahdy Y, etal. Delayed gastric emptying after pancreaticoduodenectomy. Risk factors, predictors of severity and outcome. A single center experience of 588 cases. J Gastrointest Surg. 2015;19:1093-100.

Velanovich V, Kheibek T, Khan M. Relationship of postoperative complications from preoperative biliary stents after pancreaticoduodenectomy. A new cohort analysis and meta- analysis of modern studies. JOP. 2009;10:24-9.

Yeo CJ, Cameron JL, Maher MM, etal. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg. 1995;222:580-8.

Büchler MW, Friess H, Wagner M, etal. Pancreatic fi stula after pancreatic head resection. Br J Surg 2000;87:883–889.

H J Schlitt, U Schmidt, D Simunec, etal. Morbidity and Mortality Associated With Pancreatogastrostomy and Pancreatojejunostomy Following Partial Pancreatoduodenectomy. Br J Surg. 2002;89:1245-51.

Schmidt CM, Powell ES, Yiannoutsos CT, etal. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg. 2004;139:718-25; discussion 725-7.

Shrikhande SV, Barreto G, Shukla PJ. Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy. Langenbecks Arch Surg. 2008;393:87-91.

Grobmyer SR, Kooby D, Blumgart LH, etal. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J Am Coll Surg. 2010;210:54-9.

Caronna R, Peparini N, Cosimo Russillo G, etal.Pancreaticojejuno anastomosis after pancreaticoduodenectomy: brief pathophysiological considerations for a rational surgical choice. Int J Surg Oncol. 2012;2012:636824.

Kim M, Shin WY, Lee KY, etal. An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures. Ann Hepatobiliary Pancreat Surg. 2017;21:39-47.


Refbacks

  • There are currently no refbacks.