Reyna-Sepúlveda F, Muñoz-Maldonado G, Pérez-Rodríguez E, Hernández-Trejo F, Guevara-Charles A, Hernández-Guedea M

Language: English
References: 14
Page: 205-210
PDF size: 229.33 Kb.

ABSTRACT

Background: Periampullary neoplasms account for over 30,000 cancer-related deaths per year in the United States. Pancreaticoduodenectomy (PD) is considered the surgical standard and is the only curative treatment option for these pathologies. Objective: The objective of this study was to report the prognostic factors in survival and surgical complications in PD. Materials and Methods: A total of 178 cases are reported, several variables were reviewed and the same surgical technique was used by the same surgeon. Results: A total of 151 PD were reviewed. The most common initial symptoms were jaundice, 111 (73%), abdominal pain, 20 (13%), and oral intolerance, 10 (6%). Poor prognostic factors for survival were the presence of a previous pathology, days of hospitalization, positive margins, and weight loss. Discussion: With the experience gained, a decrease in surgical time, intraoperative bleeding, and transfusions performed was achieved. Our complication rate remained at 20%, lower than that reported in literature. Conclusion: PD is the only option of cure for patients with pancreatic and periampullary tumors. This procedure has been linked to high morbidity and mortality even in high-volume centers. A pancreatic fistula is the most feared complication; therefore, multiple pancreatojejunostomy techniques have been described in literature. It is important to continue reporting these cases to reach a consensus on this technique.

REFERENCES

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71-96.

2. Hidalgo M. Pancreatic cancer. N Engl J Med. 2010;362:1605-17.

3. Crile G Jr. The advantages of bypass operations over radical pancreatoduodenectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet. 1970;130:1049-53.

4. Rocca A, Calise F, Marino G, et al. Primary giant hepatic neuroendocrine carcinoma: a case report. Int J Surg. 2014;12 Suppl 1:S218-21.

5. Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6-to 10-year follow-up. Surgery. 2006;140:764-72.

6. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg. 2004;139:718-25.

7. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931-7.

8. Balzano G, Zerbi A, Capretti G, et al. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95:357-62.

9. Armstrong T, Strommer L, Ruiz-Jasbon F, et al. Pancreaticoduodenectomy for peri-ampullary neoplasia leads to specific micronutrient deficiencies. Pancreatology. 2007;7:37-44.

10. Whipple AO. Pancreaticoduodenectomy for islet carcinoma: a five-year follow-up. Ann Surg. 1945;121:847-52.

11. Riall TS, Kuo Y, Towsend CM, et al. The Impact of Age on Surgical Resection Rates And Long-Term Survival in Patients with Locoregional Pancreatic Cancer. Vol. 151. Submitted to the 4th Annual Academic Surgical Congress; 2008. p. 284.

12. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220 530-6.

13. Kleespies A, Albertsmeier M, Obeidat F, et al. The challenge of pancreatic anastomosis. Langenbecks Arch Surg. 2008;393:459-71.

14. Dokmak S, Ftériche FS, Aussilhou B, et al. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 2015;220:831-8.