| 1 | Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy显示文摘AIM:To explore the morbidity and risk factors of postoperative pancreatic fistula(POPF)following pancreaticoduodenectomy.METHODS:The data from 196 consecutive patients who underwent pancreaticoduodenectomy,performed by different surgeons,in the General Hospital of the People’s Liberation Army between January 1st,2013and December 31st,2013 were retrospectively collected for analysis.The diagnoses of POPF and clinically relevant(CR)-POPF following pancreaticoduodenectomy were judged strictly by the International Study Group on Pancreatic Fistula Definition.Univariate analysis was performed to analyze the following factors:patient age,sex,body mass index(BMI),hypertension,diabetes mellitus,serum CA19-9 level,history of jaundice,serum albumin level,blood loss volume,pancreatic duct diameter,pylorus preserving pancreaticoduodenectomy,pancreatic drainage and pancreaticojejunostomy.Multivariate logistic regression analysis was used to determine the main independent risk factors for POPF.RESULTS:POPF occurred in 126(64.3%)of the patients,and the incidence of CR-POPF was 32.7%(64/196).Patient characteristics of age,sex,BMI,hypertension,diabetes mellitus,serum CA19-9 level,history of jaundice,serum albumin level,blood loss volume,pylorus preserving pancreaticoduodenectomy and pancreaticojejunostomy showed no statistical difference related to the morbidity of POPF or CR-POPF.Pancreatic duct diameter was found to be significantly correlated with POPF rates by univariate analysis and multivariate regression analysis,with a pancreatic duct diameter≤3 mm being an independent risk factor for POPF(OR=0.291;P=0.000)and CR-POPF(OR=0.399;P=0.004).The CR-POPF rate was higher in patients without external pancreatic stenting,which was found to be an independent risk factor for CR-POPF(OR=0.394;P=0.012).Among the entire patient series,there were three postoperative deaths,giving a total mortality rate of 1.5%(3/196),and the mortality associated with pancreatic fistula was 2.4%(3/126).CONCLUSION:A pancreatic duct diameter≤3 mm is an independent risk factor for POPF.External stent drainage of pancreatic secretion may reduce CR-POPF mortality and POPF severity. | Qi-Yu Liu Wen-Zhi Zhang Hong-Tian Xia Jian-Jun Leng Tao Wan Bin Liang Tao Yang Jia-Hong Dong | 2014 | World Journal of Gastroenterology2014，20，46： | 32 |
| 2 | Laparoscopic pancreatoduodenectomy:How far have we come and where are we headed?显示文摘Minimally invasive pancreatoduodenectomy is currently a feasible option in selected patients at high volume centers with available expertise. Although the procedure hasbeen described two decades ago, laparoscopic surgeons have been reluctant to perform it since it is technically demanding. Currently there is no standardized training process for minimally invasive pancreatoduodenectomy and this is required to ensure the safety of the procedure. Even the open pancreatoduodenectomy can be a challenging procedure where the outcome depends much upon the patient volume and surgeon's experience. In the minimally invasive setting, all the current evidence comes from retrospective data with inherent selection bias. Although the proposed benefits have been reported in many series, a randomized trial comparing with the open approach is highly unlikely to happen, given the complexity of pancreatic cancer and patient selection for complex surgery. Rather, in a disease for which cure is an utopian statement, perhaps the ultimate aim of minimally invasive pancreatoduodenectomy can be the improvement in the quality of life. Also further studies are needed to assess the immunologic role affecting the oncologic outcomes in patients undergoing minimally invasive pancreatoduodenectomy. The robotic platforms have got easily accepted since they can overcome some of the limitations of the laparoscopic platforms such as limited range of motion, two dimensional visualization and poor ergonomics. The main limitations of robotic procedures are related to the high costs associated with the system and disposable equipment. Currently evidence is lacking regarding the cost effectiveness of the procedure and also the push from the industry is on rise. All these minimally invasive techniques have a long learning curve and prior extensive experience in hepatopancreatobiliary surgery is mandatory for surgeons embarking on these endeavours. | Shailesh V Shrikhande Masillamany Sivasanker | 2015 | World Journal of Gastrointestinal Surgery2015，7，8： | 0 |
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