Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anasto...Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.展开更多
AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal ...AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012.The patients were divided into two groups based on the surgical approach:the laparoscopic surgery group and the open surgery group.The patients’demographic data,operative results,pathological reports,hospital courses,morbidity and mortality,and follow-up data were compared between the two groups.RESULTS:Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy(LDP),and 13 underwent open distal pancreatectomy(ODP).Baseline characteristics were similar between the two groups except for a female predominance in the LDP group(100.0%vs 69.2%,P=0.035).Mortality,morbidity(33.3%vs 38.5%,P=1.000),pancreatic fistula rates(26.7%vs 30.8%,P=0.728),and reoperation rates(0.0%vs 7.7%,P=0.464)were similar in the two groups.There were no significant differences in the operating time(171 min vs 178 min,P=0.755)between the two groups.The intraoperative blood loss(149 mL vs 580 mL,P=0.002),transfusion requirement(6.7%vs 46.2%,P=0.029),first flatus time(1.9d vs 3.5 d,P=0.000),diet start time(2.3 d vs 4.9 d,P=0.000),and postoperative hospital stay(8.1 d vs 12.8d,P=0.029)were significantly less in the LDP group than in the ODP group.All patients had negative surgical margins at final pathology.There were no significant differences in number of lymph nodes harvested(4.6 vs6.4,P=0.549)between the two groups.The median follow-up was 33(3-100)mo for the LDP group and 45(17-127)mo for the ODP group.All patients were alive with one recurrence.CONCLUSION:LDP for SPT has short-term benefits compared with ODP.Long-term outcomes of LDP are similar to those of ODP.展开更多
Recent advances in surgical techniques and perioperative management have markedly reduced operative morbidity after distal pancreatectomy(DP).However,some questions remain regarding the protocol for the perioperative ...Recent advances in surgical techniques and perioperative management have markedly reduced operative morbidity after distal pancreatectomy(DP).However,some questions remain regarding the protocol for the perioperative management of DP,in particular,with regard to the development of pancreatic fistula(PF).A review of DP was therefore conducted in order to standardize the management of patients for a favorable outcome.Overall,operative technique and perioperative management emerged as two critical factors contributing to favorable outcome in DP patients.As for the operative method,surgical and closure techniques exhibited differences in outcome.Laparoscopic DP generally yields more favorable perioperative outcomes compared to open DP,and is applicable for benign tumors and some ductal carcinomas of the pancreas.Robotic DP is also available for safe pancreatic surgery.En bloc celiac axis resection offers a high R0 resection rate and potentially allows for some local control in the case of advanced pancreatic cancer.Following resection,staple closure was not found to reduce the rate of PF when compared to hand-sewn closure.In addition,ultrasonic dissection devices,fibrin glue sealing,and staple closure with mesh reinforcement were shown to significantly reduce PF,although there was some bias in these studies.In perioperative management,both preoperative and postoperative treatment affected outcome.First,preoperative endoscopic pancreatic stenting may be an effective prophylactic measure against fistula development following DP in selected patients.Second,in postoperative management,a multifactorial approach including prophylactic antibiotics improved high surgical site infection rates following complex hepato-pancreatobiliary surgery.Furthermore,although conflicting results have been reported,somatostatin analogues should be administered selectively to patients considered to have a high risk for PF.Finally,careful drain management also facilitates a favorable outcome in patients with PF after DP.The results of the rev展开更多
Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the ce...Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type Ⅷb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.展开更多
Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatec...Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group （221.4 min） was significantly longer than that in the laparoscopic group （173.6 min） （P = 0.026）. Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate （52.9% vs. 38.9%） （P = 0.505）, operative blood loss （100.3 ml vs. 268.3 ml） （P = 0.29）, overall morbidity rate （47.1% vs. 38.9%） （P = 0.73）, and post-operative hospital stay （11.4 days vs. 14.2 days） （P = 0.46）. Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.展开更多
文摘Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.
基金Supported by The Key Project Grant from the Science and Technology Department of Zhejiang Province,No.2011C13036-2
文摘AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012.The patients were divided into two groups based on the surgical approach:the laparoscopic surgery group and the open surgery group.The patients’demographic data,operative results,pathological reports,hospital courses,morbidity and mortality,and follow-up data were compared between the two groups.RESULTS:Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy(LDP),and 13 underwent open distal pancreatectomy(ODP).Baseline characteristics were similar between the two groups except for a female predominance in the LDP group(100.0%vs 69.2%,P=0.035).Mortality,morbidity(33.3%vs 38.5%,P=1.000),pancreatic fistula rates(26.7%vs 30.8%,P=0.728),and reoperation rates(0.0%vs 7.7%,P=0.464)were similar in the two groups.There were no significant differences in the operating time(171 min vs 178 min,P=0.755)between the two groups.The intraoperative blood loss(149 mL vs 580 mL,P=0.002),transfusion requirement(6.7%vs 46.2%,P=0.029),first flatus time(1.9d vs 3.5 d,P=0.000),diet start time(2.3 d vs 4.9 d,P=0.000),and postoperative hospital stay(8.1 d vs 12.8d,P=0.029)were significantly less in the LDP group than in the ODP group.All patients had negative surgical margins at final pathology.There were no significant differences in number of lymph nodes harvested(4.6 vs6.4,P=0.549)between the two groups.The median follow-up was 33(3-100)mo for the LDP group and 45(17-127)mo for the ODP group.All patients were alive with one recurrence.CONCLUSION:LDP for SPT has short-term benefits compared with ODP.Long-term outcomes of LDP are similar to those of ODP.
文摘Recent advances in surgical techniques and perioperative management have markedly reduced operative morbidity after distal pancreatectomy(DP).However,some questions remain regarding the protocol for the perioperative management of DP,in particular,with regard to the development of pancreatic fistula(PF).A review of DP was therefore conducted in order to standardize the management of patients for a favorable outcome.Overall,operative technique and perioperative management emerged as two critical factors contributing to favorable outcome in DP patients.As for the operative method,surgical and closure techniques exhibited differences in outcome.Laparoscopic DP generally yields more favorable perioperative outcomes compared to open DP,and is applicable for benign tumors and some ductal carcinomas of the pancreas.Robotic DP is also available for safe pancreatic surgery.En bloc celiac axis resection offers a high R0 resection rate and potentially allows for some local control in the case of advanced pancreatic cancer.Following resection,staple closure was not found to reduce the rate of PF when compared to hand-sewn closure.In addition,ultrasonic dissection devices,fibrin glue sealing,and staple closure with mesh reinforcement were shown to significantly reduce PF,although there was some bias in these studies.In perioperative management,both preoperative and postoperative treatment affected outcome.First,preoperative endoscopic pancreatic stenting may be an effective prophylactic measure against fistula development following DP in selected patients.Second,in postoperative management,a multifactorial approach including prophylactic antibiotics improved high surgical site infection rates following complex hepato-pancreatobiliary surgery.Furthermore,although conflicting results have been reported,somatostatin analogues should be administered selectively to patients considered to have a high risk for PF.Finally,careful drain management also facilitates a favorable outcome in patients with PF after DP.The results of the rev
文摘Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type Ⅷb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.
文摘Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group （221.4 min） was significantly longer than that in the laparoscopic group （173.6 min） （P = 0.026）. Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate （52.9% vs. 38.9%） （P = 0.505）, operative blood loss （100.3 ml vs. 268.3 ml） （P = 0.29）, overall morbidity rate （47.1% vs. 38.9%） （P = 0.73）, and post-operative hospital stay （11.4 days vs. 14.2 days） （P = 0.46）. Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.
