AIM To evaluate the evolution, trends in surgical approaches a n d r e c o n s t r u c t i o n t e c h n i q u e s, a n d i m p o r t a n t lessons learned from performing 1000 consecutive pancreaticoduodenectomies(PD...AIM To evaluate the evolution, trends in surgical approaches a n d r e c o n s t r u c t i o n t e c h n i q u e s, a n d i m p o r t a n t lessons learned from performing 1000 consecutive pancreaticoduodenectomies(PDs) for periampullary tumors.METHODS This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period(1993-2002), middle period(2003-2012), and late period(2013-2017).RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.CONCLUSION Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.展开更多
Background Pancreaticogastrostomy （PG） has been proposed as an alternative to pancreaticojejunostomy （PJ）, assuming that postoperative complications are less frequent. The aim of this research was to compare the s...Background Pancreaticogastrostomy （PG） has been proposed as an alternative to pancreaticojejunostomy （PJ）, assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.展开更多
BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical techniq...BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosi展开更多
BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrost...BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrostomy(PG).METHODS This meta-analysis was performed using Review Manager 5.3.All clinical randomized controlled trials,in which patients underwent PD with pancreaticodigestive tract reconstruction via PJ or PG,were included.RESULTS The search of PubMed,Wanfang Data,EMBASE,and the Cochrane Library provided 125 citations.After further analysis,11 trials were included from nine counties.In all,909 patients underwent PG and 856 underwent PJ.Meta-analysis showed that pancreatic fistula(PF)was a significantly lower morbidity in the PG group than in the PJ group(odds ratio[OR]=0.67,95%confidence interval[CI]:0.53-0.86,P=0.002);however,grades B and C PF was not significantly different between the two groups(OR=0.61,95%CI:0.34-1.09,P=0.09).Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group(OR=1.47,95%CI:1.05-2.06,P=0.03).Delayed gastric emptying was not significantly different between the two groups(OR=1.09,95%CI:0.83-1.41,P=0.54).CONCLUSION There is no difference in the incidence of grades B and C PF between the two groups.However,postoperative bleeding is significantly higher in PG than in PJ.Binding PJ or binding PG is a safe and secure technique according to our decades of experience.展开更多
文摘AIM To evaluate the evolution, trends in surgical approaches a n d r e c o n s t r u c t i o n t e c h n i q u e s, a n d i m p o r t a n t lessons learned from performing 1000 consecutive pancreaticoduodenectomies(PDs) for periampullary tumors.METHODS This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period(1993-2002), middle period(2003-2012), and late period(2013-2017).RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.CONCLUSION Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.
文摘Background Pancreaticogastrostomy （PG） has been proposed as an alternative to pancreaticojejunostomy （PJ）, assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.
文摘BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosi
文摘BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrostomy(PG).METHODS This meta-analysis was performed using Review Manager 5.3.All clinical randomized controlled trials,in which patients underwent PD with pancreaticodigestive tract reconstruction via PJ or PG,were included.RESULTS The search of PubMed,Wanfang Data,EMBASE,and the Cochrane Library provided 125 citations.After further analysis,11 trials were included from nine counties.In all,909 patients underwent PG and 856 underwent PJ.Meta-analysis showed that pancreatic fistula(PF)was a significantly lower morbidity in the PG group than in the PJ group(odds ratio[OR]=0.67,95%confidence interval[CI]:0.53-0.86,P=0.002);however,grades B and C PF was not significantly different between the two groups(OR=0.61,95%CI:0.34-1.09,P=0.09).Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group(OR=1.47,95%CI:1.05-2.06,P=0.03).Delayed gastric emptying was not significantly different between the two groups(OR=1.09,95%CI:0.83-1.41,P=0.54).CONCLUSION There is no difference in the incidence of grades B and C PF between the two groups.However,postoperative bleeding is significantly higher in PG than in PJ.Binding PJ or binding PG is a safe and secure technique according to our decades of experience.
