Background Minimal access surgery techniques have evolved to include complex surgical procedures. Laparoscopic pancreaticoduodenectomy (LPD) is a complex operation that pancreas surgeons have been ...slow to adopt. This article reviews our experience with patients undergoing LPD and compares their outcomes with those of patients undergoing open pancreaticoduodenectomy (OPD). Study Design All patients undergoing OPD or LPD during a 6-year period (2005−2011) were included. Results from the 2 groups were compared for mortality and morbidity according to the Accordion Severity Grading System. Oncologic markers, including margins of resection, transfusions received, number of lymph nodes, and lymph node ratio, were also compared. Results During the study time period, 215 and 53 patients underwent OPD and LPD, respectively. No differences were seen in patient demographics, comorbidities, American Society of Anesthesiologists grade, or pathology. Significant differences favoring LPD were seen in intraoperative blood loss (p < 0.001), transfusions (p < 0.001), length of hospital stay (p < 0.001), and length of ICU stay (p < 0.001). Operative time was significantly longer for LPD (p < 0.001). There were no differences in overall complications, pancreas fistula, or delayed gastric emptying. Oncologic outcomes demonstrated no significant differences in resection margins, size of tumor, or T/N stages. There were significant differences in number of lymph nodes retrieved (p = 0.007) and lymph node ratio (p < 0.001) in favor of LPD. Conclusions This series demonstrates that LPD appears to be safe and feasible, with benefits over the open counterpart. However, the increased complexity and effort demanded by the technique pose the need for multi-institutional series and standardization in reporting. The goal should be to assess if LPD can result in a better procedure with better outcomes.
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GEOZS, NUK, OILJ, SBJE, UL, UPUK
Background
Laparoscopic distal pancreatectomy (LDP) has been shown to have short-term benefits over open distal pancreatectomy (ODP). Its application for pancreatic ductal adenocarcinoma (PDAC) ...remains controversial.
Methods
From 1995 to 2014, 72 patients underwent distal pancreatectomy for PDAC at a single institution and were included in the study. Postoperative and long-term outcomes of patients undergoing LDP (
n
= 44) or ODP (
n
= 28) were compared.
Results
LDP was associated with less blood loss (332 vs. 874 mL,
p
= 0.0012) and lower transfusion rates than ODP (18.2 vs. 50 %,
p
= 0.0495). Operative time was similar (254 vs. 266 min) for LDP and ODP; five patients (11.4 %) required conversion to ODP. Pancreatic fistulas (13.6 vs. 7.1 %) and major complications (13.6 vs. 25 %), were similar between LDP and ODP, respectively. Length of hospital stay (5.1 vs. 9.4 days,
p
= 0.0001) and time to initiate adjuvant therapy (69.4 vs. 95.6 days,
p
= 0.0441) was shorter for LDP than ODP. Tumor characteristics were similar but LDP was associated with more resected lymph nodes than ODP (25.9 vs. 12.7,
p
= 0.0001). One-, three-, and five-year survival rates were similar between LDP (69, 41, and 41 %, respectively) and ODP (78, 44, and 32 %, respectively).
Conclusion
LDP is associated with less blood loss and need for blood transfusion, shorter hospital stay, and faster time to initiate adjuvant therapy than ODP for patients with PDAC. Postoperative outcomes and long-term survival are similar between the two groups. LDP appears to be safe in the treatment of patients with PDAC.
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EMUNI, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, ...laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period.
Methods
From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (
n
= 193) and LPD (
n
= 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed.
Results
Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively.
Conclusion
LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Increasingly, pancreatic cysts are discovered incidentally in patients undergoing cross-sectional imaging for nonpancreatic reasons. It is unclear whether this increase is caused by improved ...detection by progressively more sophisticated cross-sectional imaging techniques or by a true increase in prevalence. We aimed to determine the prevalence of incidental pancreatic cysts in patients undergoing magnetic resonance imaging (MRI) for nonpancreatic indications on successive, increasingly sophisticated MRI systems. Also, we compared prevalence based on the demographic characteristics of the patients.
We collected data from MRIs performed at the Mayo Clinic in Florida during the sample months of January and February, from 2005 to 2014. Each patient's clinical chart was reviewed in chronological order to include the first 50 MRIs of each year (500 total). Patients were excluded if they had pancreatic disease including cysts, pancreatic surgery, pancreatic symptoms, pancreatic indication for the imaging study, or previous abdominal MRIs. An expert pancreatic MRI radiologist reviewed each image, looking for incidental pancreatic cysts.
Of the 500 patients analyzed, 208 patients (41.6%) were found to have an incidental cyst. A significant relationship was observed between pancreatic cysts and patient age (P < .0001), diabetes mellitus (P = .001), and nonpancreatic cancer (P = .01), specifically nonmelanoma skin cancer (P = .03) or hepatocellular carcinoma (P = .02). The multivariable model showed a strong association between hardware and software versions and detection of cysts (P < .0001); the old hardware detected pancreatic cysts in 30.3% of patients, whereas the newest hardware detected cysts in 56.3% of patients.
Based on an analysis of data collected from 2005 through 2014, newer versions of MRI hardware and software corresponded with higher numbers of pancreatic cysts detected. Older age, diabetes, and the presence of nonpancreatic cancer (specifically nonmelanoma skin cancer and hepatocarcinoma) were also associated with the presence of cysts.
Background/Purpose
There is uncertainty about the role of prophylactic intra‐abdominal drains after distal pancreatectomy. In the present study, we aimed to describe the long‐term outcomes of ...postoperative pancreatic collections in patients who underwent a minimally invasive distal pancreatectomy (MIDP) without surgical drain placement.
Methods
From 2018 to 2022, consecutive patients who underwent a MIDP were recorded. Patients were followed at 90 days, 6 months, and in the long term. The use of interventional procedures and antibiotic therapy were documented, and the overall evolution of the collections was assessed.
Results
A total of 91 patients underwent MIDP; 11 were excluded; 80 were analyzed. Median age was 63 (51–73) years; 61.3% were women. Most lesions (71.3%) were malignant; 15 patients received neoadjuvant therapy. Procedures were laparoscopic (87.5%) or robotic (12.5%). Incidence of postoperative pancreatic collections was 33%; 10 patients were symptomatic. Interventional endoscopic (n = 3) or percutaneous (n = 3) procedures were required. At a follow‐up of 24 (17.5–33.1) months, 18 collections resolved completely, eight partially, and one increased.
Conclusions
Patients who undergo MIDP without surgical drain placement develop well‐tolerated pancreatic collections. Although a minority may require endoscopic or percutaneous drainage, the majority can be managed conservatively and resolve spontaneously in the long term.
Lluís and colleagues investigated the feasibility and safety of a non‐drainage approach following minimally invasive distal pancreatectomy. The findings revealed that patients frequently develop generally asymptomatic pancreatic collections. Only a minority of patients may require endoscopic or percutaneous drainage, while the majority can be effectively managed conservatively, ultimately resolving spontaneously.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
No standard classification exists for post-splenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv). The goal of this study was to review our institution's experience with PST-SMPv ...and to perform a systematic literature review.
A retrospective review of all patients undergoing splenectomy from 1995-2016 at our institution was performed. Additionally, six databases and four grey literature websites were systematically searched. Splenectomy for pediatric patients or for trauma or portal hypertension related reasons were excluded.
Between 1995 and 2016, 229 patients (113; 49.3% males) underwent splenectomy for spleen related diseases at our institution. From 1895 to 2016, 1645 unique literature citations were identified. Twenty citations met our inclusion criteria. Data on 1745 splenectomized patients was compiled; PST-SMPv occurred in 141 (8.1%).
In our series, PST-SMPv developed in 6.6% of patients and the incidence of PST-SMPv after splenectomy in the literature ranges from 0.8 – 53.0%. A call for standardized reporting through a proposed classification is made.
•Incidence of PST-SMPv is approximately 8% of the total population of patients undergoing splenectomy for spleen-related pathology.•Myeloproliferative disorders and splenic size are the main risk factors for PST-SMPv.•Relevant classification for PST-SMPv was suggested.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background
Although it has been 25 years since the introduction of laparoscopy to cholecystectomy, outcomes remain largely unchanged, with rates of bile duct injury higher in the modern age than in ...the era of open surgery. The SAGES Safe Cholecystectomy Task Force (SCTF) initiative seeks to encourage a culture of safety in laparoscopic cholecystectomy (LC) and reduce biliary injury. An expert consensus study was conducted to identify interventions thought to be most effective in pursuit of this goal.
Methods
An initial list of items for safer practice in LC was identified by the SCTF through a nominal group technique (NGT) process. These were put forward to 407 SAGES committee members in two-stage electronically distributed Delphi surveys. Consensus was achieved if at least 80 % of respondents ranked an item as 4 or 5 on a Likert scale of importance (1–5). Additionally, respondents ranked five top areas of importance for the following domains: training, assessment, and research.
Results
Thirty-nine initial items were identified through NGT. Response rates for each Delphi round were 40.2 and 34 %, respectively. Final consensus was achieved on 15 items, the majority of which related to non-technical factors in LC. Key domains for training, assessment, and research were identified. Critical view of safety was deemed most important for overall safety, as well as training and assessment of LC. Intraoperative cholangiography was identified as an additional priority area for future research.
Conclusions
Consensus items to progress surgical practice, training, assessment, and research have been identified, to promote safe practice and improve patient outcomes in LC.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Bile duct injury (BDI) remains the most dreaded complication following cholecystectomy with serious repercussions for the surgeon, patient and entire healthcare system. In the absence of ...registries, the true incidence of BDI in the United States remains unknown. We aim to identify the incidence of BDI requiring operative intervention and overall complications after cholecystectomy.
Methods
Utilizing the Truven Marketscan
®
research database, 554,806 patients who underwent cholecystectomy in calendar years 2011–2014 were identified using ICD-9 procedure and diagnosis codes. The final study population consisted of 319,184 patients with at least 1 year of continuous enrollment and who met inclusion criteria. Patients were tracked for BDI and other complications. Hospital cost information was obtained from 2015 Premier data.
Results
Of the 319,184 patients who were included in the study, there were a total of 741 (0.23%) BDI identified requiring operative intervention. The majority of injuries were identified at the time of the index procedure (
n
= 533, 72.9%), with 102 (13.8%) identified within 30-days of surgery and the remainder (
n
= 106, 14.3%) between 31 and 365 days. The operative cumulative complication rate within 30 days of surgery was 9.84%. The most common complications occurring at the index procedure were intestinal disorders (1.2%), infectious (1%), and shock (0.8%). The most common complications identified within 30-days of surgery included infection (1.5%), intestinal disorders (0.7%) and systemic inflammatory response syndrome (SIRS) (0.7%) for cumulative rates of infection, intestinal disorders, shock, and SIRS of 2.0, 1.9, 1.0, and 0.8%, respectively.
Conclusion
BDI rate requiring operative intervention have plateaued and remains at 0.23% despite increased experience with laparoscopy. Moreover, cholecystectomy is associated with a 9.84% 30-day morbidity rate. A clear opportunity is identified to improve the quality and safety of this operation. Continued attention to educational programs and techniques aimed at reducing patient harm and improving surgeon skill are imperative.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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