Postoperative weight gain after standard Whipple's procedure versus pylorus-preserving pancreatoduodenectomy: the influence of tumour status.
ABSTRACT Recent reports suggest a better postoperative weight gain after pylorus-preserving pancreatoduodenectomy (PPPD) compared with standard pancreatoduodenectomy (PD). Factors that could also influence postoperative weight gain, such as tumour-positive resection margins and tumour recurrence, have not been taken into account in these studies. The aim of this prospective study was to evaluate weight gain in the first 15 months after PD or PPPD and to investigate the influence of other tumour-related factors.
From 1991 to 1995, 140 patients underwent subtotal pancreatoduodenectomy; 125 patients underwent resection for malignant disease of the pancreatic head region (56 had PD and 69 PPPD). Patients' weights were evaluated in the pre-illness phase, before operation and during four postoperative phases (at 3, 7, 11 and 15 months). Weight was calculated as a percentage of the pre-illness weight. Patients were subdivided according to tumour status: PD with positive and PD with negative tumour status; PPPD with positive and PPPD with negative tumour status. Tumour-positive status was defined as either microscopically tumour-positive resection margins or radiologically or cytologically proven tumour recurrence within 2 years of surgery.
Five patients died during the hospital stay (PD, four; PPPD, one) (overall mortality rate 4 per cent). There was no difference in overall weight gain between patients having PD and PPPD. There was, however, a difference in patients with positive and negative tumour status for PD (P = 0.0003) and PPPD (P< 0.0001).
There is only a minimal difference in postoperative weight gain between patients having PD and PPPD. Differences in postoperative weight gain are related more to positive resection margins and tumour recurrence than to the type of resection.
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ABSTRACT: This meta-analysis is to assess whether antecolic reconstruction is superior to retrocolic reconstruction for gastro/duodenojejunostomy with respect to delayed gastric emptying after pancreaticoduodenectomy. A literature search of Medline (PubMed), EMBASE, OVID, EBSCO and Cochrane database was done to identify randomized controlled trials comparing antecolic and retrocolic gastro/duodenojejunostomy after pancreaticoduodenectomy from Jan. 1991 to Apr. 2012. Four randomized controlled trials involving 189 patients, comparing antecolic reconstruction with retrocolic reconstruction were identified for inclusion. The meta-analysis revealed that there was no significant difference between the two groups in operation time (MD, 4.39; 95% CI, -19.51 to 28.28; P = 0.72), intra-operative blood loss (MD, 22.51; 95% CI, -160.56 to 205.58; P = 0.81), blood replacement (MD, -0.19; 95% CI, -0.62 to 0.23; P = 0.38), mortality (OR, 0.32; 95% CI, 0.01 to 8.26; P = 0.49), morbidity (OR, 2.25; 95% CI, 0.57 to 8.82; P = 0.24), delayed gastric emptying (OR, 0.31; 95% CI, 0.08 to 1.26; P = 0.10) and length of postoperative hospital stay (MD, -2.35; 95% CI, -7.56 to 2.86; P = 0.38). In conclusion, compared to retrocolic reconstruction, antecolic reconstruction for gastro/duodenojejunostomy does not seem to offer an advantage with respect to delayed gastric emptying after pancreaticoduodenectomy.Surgical Practice 02/2014; 18(2). DOI:10.1111/1744-1633.12055 · 0.17 Impact Factor
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ABSTRACT: Background. Pancreaticoduodenectomy is the potentially curative treatment for malignant and several benign conditions of the pancreatic head and periampullary region. While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results. Methods. We describe our early hind right approach to the retropancreatic vasculature during pancreaticoduodenectomy by mesopancreas dissection before any pancreatic or digestive transection. Results. We used this approach in 52 patients. Thirty-two had hepatic artery anatomic variant and 2 had bleeding pancreatic head pseudoaneurysm. The hepatic artery variant was preserved in all cases out of 2 in which arterial reconstruction was performed. In nine patients with intraductal papillary mucinous neoplasms the pancreaticoduodenectomy was extended to the body in 6 and totalized in 3 patients. Seven patients with adenocarcinoma involving the portomesenteric axis required venous resection and reconstruction. Conclusions. Early hind right approach is advocated in selected cases of pancreaticoduodenectomy to improve locoregional vascular control and determine, safely and early, whether there is mesopancreas involvement.Gastroenterology Research and Practice 01/2014; 2014:210835. DOI:10.1155/2014/210835 · 1.50 Impact Factor
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ABSTRACT: We showed in a previous study that pylorus-resecting pancreaticoduodenectomy (PrPD), which divides the stomach adjacent to the pylorus ring, preserves more than 95 % of the stomach and significantly reduced the incidence of delayed gastric emptying (DGE) compared with pylorus-preserving pancreaticoduodenectomy (PpPD). However, long-term outcomes of PrPD and the adverse effect of early postoperative DGE on long-term outcomes remain unclear. A total of 130 patients enrolled in a previous study were followed for 24 months after surgery. Primary endpoint was whether PrPD is a better surgical procedure than PpPD regarding long-term outcomes. Weight loss > grade 2 (Common Terminology Criteria for Adverse Events, Version 4.03) at 24 months after surgery was significantly better in group PrPD (16.2 %) than in group PpPD (42.2 %) (p = 0.011). Nutritional status and late postoperative complications were similar for the two groups. The incidence of weight loss > grade 2 at 24 months was 63.6 % in DGE patients with DGE and 25.3 % in non-DGE patients (p = 0.010). T max (time to peak (13)CO2 content in (13)C-acetate breath test) at 24 months in DGE patients was significantly delayed compared with that in non-DGE patients (27.9 ± 22.7 vs. 16.5 ± 10.1 min, p = 0.023). Serum albumin level at 24 months was higher in non-DGE patients than in those with DGE (3.7 ± 0.6 vs. 4.1 ± 0.4 g/dl, p = 0.013). PrPD offers long-term outcomes similar to those of PpPD. DGE may be associated with weight loss and poor nutritional status in patients with long-term outcomes.World Journal of Surgery 12/2013; 38(6). DOI:10.1007/s00268-013-2420-z · 2.35 Impact Factor