Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients.
Enrico Molinari,Claudio Bassi,Roberto Salvia,Giovanni Butturini,Stefano Crippa,Giorgio Talamini,Massimo Falconi,Paolo Pederzoli +7 more
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TL;DR: AVD in POD1 ≥5000 U/L is the only significant predictive factor of PF development and it is concluded that this study identified the predictive role of different risks factors in the development of PF.
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Abstract: Pancreaticoduodenectomy (PD) and distal pancreatic resection (DP) are now standardized interventions for benign and malignant pancreatic lesions. Because of recent improvements in surgical techniques and perioperative management, the incidence of mortality and morbidity have decreased, even if the latter is still around 20% to 50% in high volume centers.1–22 The most frequent postoperative complication is pancreatic fistula (PF), which is often associated with abdominal collections, abscesses, sepsis, and hemorrhage, with the necessity of reintervention, extended hospitalization, and postoperative mortality in 40% of cases with complications.1–8
Despite its importance, PF has still not been uniformly defined.12,13 Recently, the International Study Group on Pancreatic Fistula (ISGPF)13 established that the most appropriate PF definition and grading should be based on the clinical impact of PF-related complications. In addition, there are still no reliable correlations between the output of drains and their concentration of amylase contained within, which is useful for the diagnosis of chemical PF; moreover only a few studies have attempted to correlate the concentration of amylase in drain fluid with the risk of developing complications.23–26
In the present study we examined, within the first postoperative day (POD1), the predictive role of different risks factors, including the value of amylase in drains in the development of PF.
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Citations
The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula : 11 Years After
Claudio Bassi,Giovanni Marchegiani,Christos Dervenis,Sarr Mg,Mohammad Abu Hilal,Mustapha Adam,Peter J. Allen,Roland Andersson,Horacio J. Asbun,Marc G. Besselink,Kevin C. Conlon,Marco Del Chiaro,Massimo Falconi,Laureano Fernández-Cruz,Carlos Fernandez-del Castillo,Abe Fingerhut,Helmut Friess,Dirk J. Gouma,Thilo Hackert,Jakob R. Izbicki,Keith D. Lillemoe,John P. Neoptolemos,Attila Oláh,Richard D. Schulick,Shailesh V. Shrikhande,Tadahiro Takada,Kyoichi Takaori,William Traverso,C. Vollmer,Christopher L. Wolfgang,Charles J. Yeo,Roberto Salvia,M.W. Büchler +32 more
TL;DR: This new definition and grading system of postoperative pancreatic Fistula should lead to a more universally consistent evaluation of operative outcomes after pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula.
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Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial.
Claudio Bassi,Enrico Molinari,Giuseppe Malleo,Stefano Crippa,Giovanni Butturini,Roberto Salvia,Giorgio Talamini,Paolo Pederzoli +7 more
TL;DR: In patients at low risk of pancreatic fistula, intra-abdominal drains can be safely removed on POD 3 after standard pancreatic resections, and a prolonged period of drain insertion is associated with a higher rate of postoperative complications with increased hospital stay and costs.
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Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy
Sébastien Gaujoux,Alexandre Cortes,Anne Couvelard,Séverine Noullet,Laurent Clavel,Vinciane Rebours,Philippe Lévy,Alain Sauvanet,Philippe Ruszniewski,Jacques Belghiti +9 more
TL;DR: The presence of an increased BMI, the presence of fatty pancreas, and the absence of Pancreatic fibrosis as risk factors of PF allows a more precise and objective prediction of PF than the consistency of pancreatic remnant alone.
351
Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery
Manabu Kawai,Satoshi Kondo,Hiroki Yamaue,Keita Wada,Keiji Sano,Fuyuhiko Motoi,Michiaki Unno,Sohei Satoi,A-Hon Kwon,Takashi Hatori,Masakazu Yamamoto,Joe Matsumoto,Yoshiaki Murakami,Ryuichiro Doi,Masahiro Ito,Shuichi Miyakawa,Hiroyuki Shinchi,Shoji Natsugoe,Hisatoshi Nakagawara,Tetsuo Ohta,Tadahiro Takada +20 more
TL;DR: The four predictive risk factors identified here can provide useful information useful for tailoring postoperative management of clinically relevant pancreatic fistula (grade B/C) after pancreaticoduodenectomy.
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Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer.
Roberto Girelli,Isabella Frigerio,Roberto Salvia,Emilio Barbi,P. Tinazzi Martini,Claudio Bassi +5 more
TL;DR: Radiofrequency ablation may be a valuable treatment option for locally advanced pancreatic cancer and the feasibility and safety of this treatment is examined.
208
References
Postoperative pancreatic fistula: an international study group (ISGPF) definition.
Claudio Bassi,Christos Dervenis,Giovanni Butturini,Abe Fingerhut,Charles J. Yeo,Jakob R. Izbicki,John P. Neoptolemos,Michael G. Sarr,William Traverso,M.W. Büchler +9 more
TL;DR: In this article, an international panel of pancreatic surgeons, working in well-known, high-volume centers, reviewed the literature on the topic and worked together to develop a simple, objective, reliable, and easy-to-apply definition of postoperative pancreatic fistula, graded primarily on clinical impact.
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Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes.
Charles J. Yeo,John L. Cameron,Taylor A. Sohn,Keith D. Lillemoe,Henry A. Pitt,Mark A. Talamini,Ralph H. Hruban,Sarah E. Ord,Patricia K. Sauter,Jo Ann Coleman,Marianna Zahurak,Louise B. Grochow,Ross A. Abrams +12 more
TL;DR: This single institution, high-volume experience indicates that pancreaticoduodenectomy can be performed safely for a variety of malignant and benign disorders of the pancreas and periampullary region.
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Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume.
Dirk J. Gouma,Rutger C. I. van Geenen,Thomas M. van Gulik,Rob J. de Haan,Laurens Th de Wit,Olivier R. Busch,Huug Obertop +6 more
TL;DR: The overall death rate after pancreaticoduodenectomy did not decrease significantly during the period, and it was greater in low-volume hospitals and older patients, while the lower death and complication rates in high- volume hospitals were similar to those reported in other countries and may be due to better prevention and management of complications.
866
One hundred and forty-five consecutive pancreaticoduodenectomies without mortality.
John L. Cameron,Henry A. Pitt,Charles J. Yeo,Keith D. Lillemoe,Howard S. Kaufman,Jo Ann Coleman +5 more
TL;DR: With appropriate preoperative selection, virtually any patient in any age group, with benign or malignant disease, can undergo pancreaticoduodenectomy with minimal risk of hospital mortality.
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Ten-Year Experience With 733 Pancreatic Resections: Changing Indications, Older Patients, and Decreasing Length of Hospitalization
James H. Balcom,David W. Rattner,Andrew L. Warshaw,Yuchiao Chang,Carlos Fernandez-del Castillo +4 more
TL;DR: There has been a significant decrease in LOS; this is the result of implementation of case management and clinical pathways, increasing case volume, decreasing incidence of delayed gastric emptying, and decreasing use of pylorus-preserving PD.
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