AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two ...AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer. Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage. RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) devel-oped postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%) developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice, preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups. There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy. Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors, pancreatic duct size and texture of the remnant pancreas, were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88% in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time, blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis, and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical signific-ance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis. By further analyzing with multivariate logistic regression, both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P= 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor, pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy. CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mucosa pancreaticojejunostomy, as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD.展开更多
AIM： To distinguish anastomotic from parenchymal leakage at duct-to-mucosa reconstruction of the pancreatic remnant. METHODS： We reviewed the charts of 68 pancreaticoduodenectomies performed between 5/2000 and 12/20...AIM： To distinguish anastomotic from parenchymal leakage at duct-to-mucosa reconstruction of the pancreatic remnant. METHODS： We reviewed the charts of 68 pancreaticoduodenectomies performed between 5/2000 and 12/2005 with end-to-side duct-to-mucosa pancreatojejunostomy （PJ）. The results of pancreatography, as well as peripancreatic drain volumes, and amylase levels were analyzed. RESULTS： Of 68 pancreatojejunostomies, 48 had no leak by pancreatography and had low-drain amylase （normal）; eight had no pancreatographic leak but had elevated drain amylase （parenchymal leak）; and 12 had pancreatographic leak and elevated drain amylase （anastomotic leak）. Although drain volumes in the parenchymal leak group were significantly elevated at postoperative day （POD） 4, no difference was found at POD 7. Drain amylase level was not significantly different at POD 4. In contrast, at POD 7, the anastomotic-leak group had significantly elevated drain amylase level compared with normal and parenchymalleak groups （14158 ＋ 24083 IU/L vs 89 ＋ 139 IU/L and 1707 ＋ 1515 IU/L, respectively, P = 0.012）. CONCLUSION： For pancreatic remnant reconstruction after pancreaticoduodenectomy, a combination of pancreatogram and peripancreatic drain amylase levels can be used to distinguish between parenchymal and anastomotic leakage at pancreatic remnant reconstruction.展开更多
Objective：The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy（LDP）and open distal pancreatectomy（ODP）at a single center.Methods：Dis...Objective：The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy（LDP）and open distal pancreatectomy（ODP）at a single center.Methods：Distal pancreatectomies performed for pancreatic ductal adenocarcinoma during a 4-year period were included in this study.A retrospective analysis of a database of this cohort was conducted.Results：Twenty-two patients underwent LDP for pancreatic ductal adenocarcinoma,in comparison to seventy-six patients with comparable tumor characteristics treated by ODP.No patients with locally advanced lesions were included in this study.Comparing LDP group to ODP group,there were no significant differences in operation time（P=0.06）or blood loss（P=0.24）.Complications（pancreatic fistula,P=0.62;intra-abdominal abscess,P=0.44;postpancreatectomy hemorrhage,P=0.34）were similar.There were no significant differences in the number of lymph nodes harvested（11.2±4.6 in LDP group vs.14.4±5.5 in ODP group,P=0.44）nor the rate of patients with positive lymph nodes（36%in LDP group vs.41%in ODP group,P=0.71）.Incidence of positive margins was similar（9%in LDP group vs.13%in ODP group,P=0.61）.The mean overall survival time was（29.6±3.7）months for the LDP group and（27.6±2.1）months for ODP group.There was no difference in overall survival between the two groups（P=0.34）.Conclusions：LDP is a safe and effective treatment for selected patients with pancreatic ductal adenocarcinoma.A slow-compression of pancreas tissue with the GIA stapler is effective in preventing postoperative pancreatic fistula.The oncologic outcome is comparable with the conventional open approach.Laparoscopic radical antegrade modular pancreatosplenectomy contributed to oncological clearance.展开更多
文摘AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer. Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage. RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) devel-oped postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%) developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice, preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups. There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy. Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors, pancreatic duct size and texture of the remnant pancreas, were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88% in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time, blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis, and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical signific-ance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis. By further analyzing with multivariate logistic regression, both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P= 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor, pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy. CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mucosa pancreaticojejunostomy, as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD.
文摘AIM： To distinguish anastomotic from parenchymal leakage at duct-to-mucosa reconstruction of the pancreatic remnant. METHODS： We reviewed the charts of 68 pancreaticoduodenectomies performed between 5/2000 and 12/2005 with end-to-side duct-to-mucosa pancreatojejunostomy （PJ）. The results of pancreatography, as well as peripancreatic drain volumes, and amylase levels were analyzed. RESULTS： Of 68 pancreatojejunostomies, 48 had no leak by pancreatography and had low-drain amylase （normal）; eight had no pancreatographic leak but had elevated drain amylase （parenchymal leak）; and 12 had pancreatographic leak and elevated drain amylase （anastomotic leak）. Although drain volumes in the parenchymal leak group were significantly elevated at postoperative day （POD） 4, no difference was found at POD 7. Drain amylase level was not significantly different at POD 4. In contrast, at POD 7, the anastomotic-leak group had significantly elevated drain amylase level compared with normal and parenchymalleak groups （14158 ＋ 24083 IU/L vs 89 ＋ 139 IU/L and 1707 ＋ 1515 IU/L, respectively, P = 0.012）. CONCLUSION： For pancreatic remnant reconstruction after pancreaticoduodenectomy, a combination of pancreatogram and peripancreatic drain amylase levels can be used to distinguish between parenchymal and anastomotic leakage at pancreatic remnant reconstruction.
基金supported by the Zhejiang Provincial Natural Science Foundation of China(No.LY17H160026)
文摘Objective：The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy（LDP）and open distal pancreatectomy（ODP）at a single center.Methods：Distal pancreatectomies performed for pancreatic ductal adenocarcinoma during a 4-year period were included in this study.A retrospective analysis of a database of this cohort was conducted.Results：Twenty-two patients underwent LDP for pancreatic ductal adenocarcinoma,in comparison to seventy-six patients with comparable tumor characteristics treated by ODP.No patients with locally advanced lesions were included in this study.Comparing LDP group to ODP group,there were no significant differences in operation time（P=0.06）or blood loss（P=0.24）.Complications（pancreatic fistula,P=0.62;intra-abdominal abscess,P=0.44;postpancreatectomy hemorrhage,P=0.34）were similar.There were no significant differences in the number of lymph nodes harvested（11.2±4.6 in LDP group vs.14.4±5.5 in ODP group,P=0.44）nor the rate of patients with positive lymph nodes（36%in LDP group vs.41%in ODP group,P=0.71）.Incidence of positive margins was similar（9%in LDP group vs.13%in ODP group,P=0.61）.The mean overall survival time was（29.6±3.7）months for the LDP group and（27.6±2.1）months for ODP group.There was no difference in overall survival between the two groups（P=0.34）.Conclusions：LDP is a safe and effective treatment for selected patients with pancreatic ductal adenocarcinoma.A slow-compression of pancreas tissue with the GIA stapler is effective in preventing postoperative pancreatic fistula.The oncologic outcome is comparable with the conventional open approach.Laparoscopic radical antegrade modular pancreatosplenectomy contributed to oncological clearance.
