Humans ; Pancreatectomy ; adverse effects ; methods ; Postoperative Complications ; Spleen ; blood supply

In order to further standardize the prevention and treatment of postoperative complications of pancreatic surgery, the editorial board of the Chinese Journal of Surgery organized relevant experts to formulate this guideline under the promotion of the Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association. According to the grading of recommendations assessment, development, and evaluation system, this guide discusses the hot issues on postoperative complications such as pancreatic fistula, biliary fistula, chylous fistula, post-pancreatectomy hemorrhage, abdominal infection, delayed gastric emptying, etc., quantitatively evaluates the level of evidence in clinical studies, and forms recommendations after repeatedly consulting. It is hoped to provide reference for pancreatic surgeons in the prevention and treatment of postoperative complications.
Humans ; Postoperative Complications/etiology* ; Pancreatectomy/adverse effects* ; Pancreaticoduodenectomy/adverse effects* ; Pancreatic Fistula/prevention & control* ; China

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgical resection, when possible, remains the primary treatment modality and can result in long-term cure. The value of more radical resection remains open to debate, despite the negative results of some recent randomized trials with standard vs. extended lymphadenectomy. More effective patient selection, more rational resection, and more compositive treatment should be emphasized in management strategies. In the future, appropriately designed randomized trials of standard vs. extended resections may confirm the benefit of extended surgical resections. In addition, well powered trials of adjuvant therapies strategies together with surgical resections may identify more effective combinations, which may improve the survival of patients with pancreatic cancer.
Humans ; Lymph Node Excision ; methods ; Pancreatectomy ; methods ; trends ; Pancreatic Neoplasms ; pathology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; methods

Acute Disease ; Adult ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; Pancreatitis ; etiology ; Young Adult

BACKGROUNDDistal pancreatectomy traditionally included splenectomy; the spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation. The aim of this research was to study the feasibility, safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy.

METHODSA retrospective review was performed for 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy (n = 13) or splenic preservation (n = 13) at the First Hospital of Sun Yat-sen University and Guangdong General Hospital in Southern China from May 2002 to April 2009.

RESULTSAll 26 pancreatectomies with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in mean operative time ((172 ± 47) minutes vs. (157 ± 52) minutes, P > 0.05), intraoperative estimated blood loss ((183 ± 68) ml vs. (160 ± 51) ml, P > 0.05), incidence of noninfectious and infection complication and mean length of postoperative hospital stay ((10.1 ± 2.2) days vs. (12.1 ± 4.6) days, P > 0.05). The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than the other group ((37.3 ± 12.8) × 10(9)/L vs. (54.7 ± 13.2) × 10(9)/L, P < 0.05).

CONCLUSIONSSpleen-preserving distal pancreatectomy appears to be a feasible and safe procedure. In selected cases of benign or low-grade malignant disease, spleen-preserving distal pancreatectomy is recommended.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; methods ; mortality ; Perioperative Period ; Retrospective Studies ; Spleen ; blood supply

OBJECTIVETo evaluate the pancreatic fistula affected by different type of pancreaticojejunostomy after pancreaticoduodenectomy.

METHODSElectronic databases PubMed, EMBase, COCHRANE Library, Wanfang, and VIP etc were used to search for randomized controlled trials or non randomized prospective controlled trials reported before September 2013 on clinical effects of pancreaticojejunostomy after pancreaticoduodenectomy. The statistical analysis was done by Review Manager 5.0.

RESULTSA total of 8 trials were included in this meta-analysis. The effects of duct-to-mucosa pancreaticojejunostomy (dmPJ) and invaginating pancreaticojejunostomy (iPJ) on postoperative complication in five studies were compared, and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR = 0.77, 95% CI:0.35-1.69, P = 0.52), reoperation (M-H:OR = 1.38, 95% CI:0.64-2.95, P = 0.41) and mortality (M-H:OR = 1.15, 95% CI:0.42-3.13, P = 0.79) between dmPJ and iPJ. The effects of binding pancreaticojejunostomy (bPJ) and conventional pancreaticojejunostomy (cPJ) (including duct-to-mucosa pancreaticojejunostomy and invaginating pancreaticojejunostomy) on postoperative complication were compared, and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR = 0.57, 95% CI = 0.28-1.17, P = 0.13) , reoperation (M-H:OR = 1.18, 95% CI = 0.48-2.92, P = 0.72) and mortality (M-H:OR = 0.74, 95% CI = 0.27-1.99, P = 0.55) between bPJ and cPJ.

CONCLUSIONThere are no significant differences between dmPJ and iPJ in pancreatic fistula reoperation and mortality, and there are also no significant differences between bPJ and cPJ.

Anastomosis, Surgical ; adverse effects ; Humans ; Pancreas ; surgery ; Pancreatectomy ; adverse effects ; Pancreatic Fistula ; etiology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; Pancreaticojejunostomy ; Postoperative Complications ; surgery ; Postoperative Period ; Prospective Studies ; Randomized Controlled Trials as Topic ; Reoperation

We present here a case of acrodermatitis enteropathica-like eruption associated with essential free fatty acid and protein deficiencies as well as borderline zinc deficiency that occurred after Whipple's operation in a 31-yr-old woman. Her eruptions were improved not by zinc supplements alone, but her condition was improved by total parenteral nutrition including amino acids, albumin, lipid and zinc. Although we could not exactly decide which of the nutrients contributed the most to her manifestations, we inferred that all three elements in concert caused her dermatoses. This case shows that even though the patient's skin manifestations and laboratory results are suggestive of acrodermatitis enteropathica, the physicians should keep in mind the possibility that this disease can be associated with other nutritional deficiencies such as free fatty acid or protein deficiency.
Acrodermatitis/*diagnosis/*etiology ; Adult ; Fatty Acids, Essential/deficiency ; Female ; Humans ; Malnutrition/*diagnosis/*etiology ; Pancreatectomy/*adverse effects ; Protein-Losing Enteropathies/diagnosis/etiology ; Skin Diseases/*diagnosis/*etiology ; Zinc/deficiency

OBJECTIVETo analyze the indication and choice of operation technique for duodenum-preserving resection of pancreatic head.

METHODSThe Clinical material of the 22 patients who received duodenum-preserving resection of pancreatic head (DPPHR) from January 2001 to January 2006 was analyzed. Of the 22 cases, 8 cases presented with mucinous cystadenoma, 2 cases with mucinous cystadenocarcinoma, 4 cases with solid-pseudopapillary tumors, 2 cases with pancreatic endocrine tumors, 4 cases with chronic pancreatitis, 1 case with lymph epidermis cyst, 1 case with serous cystadenoma. The indication, choice of operation technique of DPPHR and the prevention and management of the post-operative complications were investigated.

RESULTSNo patient died of the operation. Three cases (13.6%) developed pancreatic fistula after the operation, 1 case (4.5%) developed biliary fistula, 1 case (4.5%) developed abdominal infection and 2 cases of duodenal fistula occurred (9.1%).

CONCLUSIONSDPPHR retains the continuity of stomach, duodenum and biliary ducts. The operation is safe and it reduces wounds and excision scope. This procedure can be used in benign and low malignant lesions in the head and neck of the pancreas.

Adult ; Aged ; Duodenum ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Neoplasms ; surgery ; Pancreatitis ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the clinical outcome of 21 cases of total pancreatectomy.

METHODSThe clinical data of 21 cases of total pancreatectomy performed from April 2003 to June 2006 was retrospectively analyzed.

RESULTSAmong the 21 patients, 1 case combined with transverse colon resection, 1 case with total gastrectomy, 9 cases with portal-superior mesentery vein resection with end-to-end anastomosis, 9 cases with portal-superior mesentery vein resection and grafts implantation, 8 cases with concomitant celiac axis resection, 4 cases with concomitant celiac axis and common hepatic artery resection, 1 case with concomitant celiac axis, portal vein and superior mesentery artery resection and reconstruction. Complications occurred in 12 cases (57.1%) post the operation and 5 cases (23.8%) died in 30 days after the operation. Insulin was given at the dose of 18 - 28 U daily post operation and blood glucose was maintained normal effectively. Sixteen cases were followed-up and median survival was 9.2 months (1.2 - 13.0 months). The median survival of tubular adenocarcinoma and intraductal papillary mucinous neoplasms of the pancreas (IPMNs) were 7 months (1.2 - 9.0 months) and 11.3 months (10.0 - 13.0 months), respectively.

CONCLUSIONSTotal pancreatectomy could not improve survival and it increases the complications and death, but it could improve the quality of life. It's an operation of choice for IPMNs, but with pancreatic carcinoma, the warranty of operation should be considered. The blood glucose level could be maintained normal effectively after the operation.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Quality of Life ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).

METHODSThree hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.

RESULTSNo statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.

CONCLUSIONSGenerally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.

Anastomosis, Surgical ; Humans ; Incidence ; Octreotide ; therapeutic use ; Pancreas ; pathology ; Pancreatectomy ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; drug therapy ; Pancreaticoduodenectomy ; adverse effects ; Perioperative Period ; Prospective Studies