Objective: To explore the development of the pancreatic surgeon technique in a high-volume center. Methods: A total of 284 cases receiving pancreatic surgery by a single surgeon from June 2015 to December 2020 were retrospectively included in this study. The clinical characteristics and perioperative medical history were extracted from the medical record system of Zhongshan Hospital,Fudan University. Among these patients,there were 140 males and 144 females with an age (M (IQR)) of 61.0 (16.8) years(range: 15 to 85 years). The "back-to-back" pancreatic- jejunal anastomosis procedure was used to anastomose the end of the pancreas stump and the jejunal wall. Thirty days after discharge,the patients were followed by outpatient follow-up or telephone interviews. The difference between categorical variables was analyzed by the Chi-square test or the CMH chi-square test. The statistical differences for the quantitative data were analyzed using one-way analysis of variance or Kruskal-Wallis H test and further analyzed using the LSD test or the Nemenyi test,respectively. Results: Intraoperative blood loss in pancreaticoduodenectomy between 2015 and 2020 were 300,100(100),100(100),100(0),100(200) and 150 (200) ml,respectively. Intraoperative blood loss in distal pancreatectomy was 250 (375),100 (50),50 (65), 50 (80),50 (50),and 50 (100) ml,respectively. Intraoperative blood loss did not show statistical differences in the same operative procedure between each year. The operative time for pancreaticoduodenectomy was respectively 4.5,5.0(2.0),5.5(0.8),5.0(1.3),5.0(3.3) and 5.0(1.0) hours in each year from 2015 to 2020,no statistical differences were found between each group. The operating time of the distal pancreatectomy was 3.8 (0.9),3.0 (1.5),3.0 (1.8),2.0 (1.1),2.0 (1.5) and 3.0(2.0) hours in each year,the operating time was obviously shorter in 2018 compared to 2015 (P=0.026) and 2020 (P=0.041). The median hospital stay in 2020 for distal pancreatectomy was 3 days shorter than that in 2019. The overall incidence of postoperative pancreatic fistula gradually decreased,with a incident rate of 50.0%,36.8%,31.0%,25.9%,21.1% and 14.8% in each year. During this period,in a total of 3,6,4,2,0 and 20 cases received laparoscopic operations in each year. The incidence of clinically relevant pancreatic fistula (grade B and C) gradually decreased,the incident rates were 0,4.8%,7.1%,3.4%,4.3% and 1.4%,respectively. Two cases had postoperative abdominal bleeding and received unscheduled reoperation. The overall rate of unscheduled reoperation was 0.7%. A patient died within 30 days after the operation and the overall perioperative mortality was 0.4%. Conclusion: The surgical training of a high-volume center can ensure a high starting point in the initial stage and steady progress of pancreatic surgeons,to ensure the safety of pancreatic surgery.
Male ; Female ; Humans ; Pancreatic Fistula/surgery* ; Retrospective Studies ; Blood Loss, Surgical ; Pancreatectomy/methods* ; Pancreaticoduodenectomy ; Postoperative Complications ; Surgeons ; Postoperative Hemorrhage ; Pancreatic Neoplasms/surgery*

Postpancreatectomy acute pancreatitis (PPAP) is an acute inflammation of the remnant pancreas in the early postoperative period caused by a variety of factors. With the progress of related research,PPAP has been confirmed as an independent risk factor for many severe complications such as postoperative pancreatic fistula. In some cases, it progresses to necrotizing PPAP, increasing the risk of mortality. Currently, the International Study Group for Pancreatic Surgery has standardized and graded PPAP as an independent complication, taking into account factors including serum amylase, radiological features, and clinical impact. This review summarizes how the concept of PPAP was proposed, as well as the latest progress in the research related to its etiology, prognosis, prevention, and treatment. However, given the large heterogeneity of relevant studies and the fact that they were mostly retrospective, in the future, it is necessary to place more emphasis on PPAP and elucidate the problems through more standardized studies to optimize strategies for the prevention and management of complications after pancreatic surgery.
Humans ; Pancreatitis/complications* ; Retrospective Studies ; Acute Disease ; Pancreas ; Postoperative Complications/etiology* ; Pancreatic Fistula/etiology* ; Pancreaticoduodenectomy/adverse effects*

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

Pancreaticojejunostomy is the most common anastomosis following pancreaticoduodenectomy and middle pancreatectomy. The detailed surgical technics of pancreaticojejunostomy vary dramatically, but none of them can achieve zero fistula rate. In recent years,with the development of new surgical concept,application of new surgical technology, high-tech materials and instruments,the incidence of pancreatic fistula has decreased. At the same time,researches on investigating the risk factors of pancreaticojejunostomy are gradually deepening. Based on years of surgical experience on pancreaticojejunostomy and current literatures, this paper analyzes the factors affecting the effect of pancreaticojejunostomy, such as the patient's basic physical state,pancreatic texture and diameter of the pancreatic duct,pathology and course of the disease,surgical technology and perioperative management,and summarizes six technical principles for pancreaticojejunostomy to be shared with surgical comrades:appropriate tension,protection of blood supply,hermetic closure of pancreatic section,accurate connection of pancreatic duct and intestinal mucosa,individualization,learning and accumulation of experience.
Anastomosis, Surgical/adverse effects* ; Humans ; Pancreatic Fistula/prevention & control* ; Pancreaticoduodenectomy/adverse effects* ; Pancreaticojejunostomy/adverse effects* ; Postoperative Complications/epidemiology* ; Treatment Outcome

complications during the 2 periods were evaluated.RESULTS: The rates of achieving no gross disease after cytoreductive surgery were 80.0% in the initial learning period and 83.6% in the post-learning period (p=0.560). The incidence of anastomotic leakage after rectosigmoid resection, symptomatic pleural effusion or pneumothorax after right diaphragm resection, and pancreatic fistula after splenectomy with distal pancreatectomy in the 2 periods were 2 of 34 (6.0%), 1 of 33 (3.0%), and 3 of 15 (20.0%) patients in the initial learning period, and 12 of 147 (8.2%), 1 of 118 (0.8%), and 11 of 84 (13.1%) patients in the post-learning period, respectively. There were no significant differences between the 2 groups (p=0.270, p=0.440, p=0.520, respectively).CONCLUSION: Bowel resection and upper abdominal surgery can be performed safely by gynecologic oncologists.]]>
Anastomotic Leak ; Certification ; Cytoreduction Surgical Procedures ; Diaphragm ; Gynecology ; Humans ; Incidence ; Learning ; Obstetrics ; Ovarian Neoplasms ; Pancreatectomy ; Pancreatic Fistula ; Pleural Effusion ; Pneumothorax ; Postoperative Complications ; Splenectomy

PURPOSE: The purpose of this study was to investigate whether the indicators of nutritional risk screening tool are associated with postoperative complications following pancreaticoduodenectomy (PD). METHODS: We investigated whether nutritional risk is associated with postoperative complications based on the medical records of 128 patients who underwent PD from 2010. The tool was composed of 6 risk factors: albumin, total lymphocyte count, body mass index, weight loss, dietary intake loss, and nutritional symptoms. The patients were divided into 2 groups: a nutritional risk group and a nonrisk group. The rates of general complications and postoperative pancreatic fistula (POPF) were investigated according to this nutritional status. RESULTS: There were 65 patients who did not have any risk factors. However, 63 patients had one risk factor or more. In the nonrisk group, the overall complication rate and serious complication rate were 30.8% and 15.4%, respectively. If there were one or more risk factors, the overall and serious complication rates were 59.5% and 41.3%, respectively (P = 0.001 and P = 0.001, respectively). The rate of clinically relevant POPF (grade B or C) was 9.2% in the nonrisk group. However, this rate was 23.8% in the NRS risk group (P = 0.029). In multivariate analysis, the NRS risk group was a significant factor of clinically relevant POPF (odds ratio, 9.878; 95% confidence interval, 1.527–63.914; P = 0.016). CONCLUSION: There were statistically significant associations between complications and nutritional indicators. A comprehensive analysis of nutritional parameters will help predict postoperative complications.
Body Mass Index ; Humans ; Lymphocyte Count ; Mass Screening ; Medical Records ; Mortality ; Multivariate Analysis ; Nutritional Status ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Postoperative Complications ; Risk Factors ; Weight Loss

PURPOSE: Laparoscopic distal pancreatectomy (LDP) has been widely performed for solid pseudopapillary neoplasm (SPN) involving the body or tail of the pancreas. However, it has not been established whether spleen preservation in LDP is oncologically safe for the treatment of SPN with malignant potential. In this study, we compared the short- and long-term outcomes between patients with SPN who underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) vs laparoscopic distal pancreatectomy with splenectomy (LDPS). METHODS: We retrospectively reviewed the medical records of 46 patients with SPN who underwent LDP between January 2005 and November 2016. Patients were divided into 2 groups according to spleen preservation: the LSPDP group (n=32) and the LDPS group (n=14). Clinicopathologic characteristics and perioperative outcomes were compared between groups. RESULTS: There were no significant differences in pathologic variables, including tumor size, tumor location, node status, angiolymphatic invasion, or perineural invasion between groups. Median operating time was significantly longer in the LSPDP group vs the LDPS group (243 vs 172 minutes; p=0.006). Estimated intraoperative blood loss was also significantly greater in the LSPDP group (310 vs 167 ml; p=0.063). There were no significant differences in incidence of postoperative complications (≥ Clavien-Dindo class IIIa) or pancreatic fistula between groups. After a median follow-up of 35 months (range, 3S153 months), there was no recurrence or disease-specific mortality in either group. CONCLUSION: The results show that LSPDP is an oncologically safe procedure for SPN involving the body or tail of the pancreas.
Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Mortality ; Pancreas ; Pancreatectomy ; Pancreatic Fistula ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Spleen ; Splenectomy ; Tail

PURPOSE: Pancreatic trauma is infrequent because of its central, deep anatomical position. This contributes to a lack of surgeon experience and many debates exist about its standard care. This study aimed to investigate the postoperative pancreatic fistula (POPF) and mortality of pancreatic trauma after operation. METHODS: We reviewed records in the trauma registry of our institution submitted from January 2006 to December 2016. The grade of pancreatic injury, surgical management, morbidity, mortality, and other clinical variables included in the analyses. RESULTS: Data from a total of 26,072 trauma patients admitted to the Emergency Department were analyzed. Pancreatic trauma was observed in 114 of these patients (0.44%). Laparotomy was performed in 81 patients (2 pan creatico duodenectomies, 2 pancreaticogastrostomies, peripancreatic drainage in 41 patients, distal pancreatectomies in 34 patients, and 9 patients who underwent surgery for damage control). The incidence of POPF was 38.3%. The overall mortality was 8.8% (7 of 81). In multivariate analysis, pancreas injury grade IV (≥4) (adjusted odds ratio [AOR], 4.071; P = 0.029) and preoperative peritonitis signs (AOR, 2.903; P = 0.039) were independent risk factors for POPF. All patients who died had also another major abdominal injury (≥grade 3). Multiorgan failure was a major cause of death (6 of 7, 85.7%). The mortality rate of isolated pancreas injury was 0%. CONCLUSION: The pancreas injury grade and preoperative peritonitis were significant risk factors of POPF. The mortality rate of isolated pancreatic trauma was very low.
Abdominal Injuries ; Cause of Death ; Drainage ; Emergency Service, Hospital ; Humans ; Incidence ; Intraoperative Complications ; Laparotomy ; Mortality* ; Multivariate Analysis ; Odds Ratio ; Pancreas ; Pancreatectomy ; Pancreatic Fistula* ; Peritonitis ; Risk Factors ; Trauma Centers*

PURPOSE: Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. METHODS: From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status. RESULTS: The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6–137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%. CONCLUSION: Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.
Health Personnel ; Hospital Costs ; Hospital Mortality ; Hospitals, Municipal* ; Humans ; Insurance Coverage ; Length of Stay ; Local Government ; Mortality ; National Health Programs ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Postoperative Complications ; Public Health ; Retrospective Studies ; Seoul ; United States

PURPOSE: Patients who develop complications consume a disproportionately large share of available resources in surgery; therefore the attention of healthcare funders focuses on the economic impact of complications. The main objective of this work was to assess the clinical and economic impact of postoperative complications in pancreatic surgery, and furthermore to assess risk factors for increased costs. METHODS: In all, 161 consecutive patients underwent pancreatic resection. The costs of the treatment were determined and analyzed. RESULTS: The overall morbidity rate was 53.4%, and the in-hospital mortality rate was 3.7%. The median of costs for all patients without complication was 3,963 Euro, whereas the median of costs for patients with at least one complication was significantly increased at 10,670 Euro (P < 0.001). In multivariate analysis American Society of Anesthesiologists > or = 3 (P = 0.006), multivisceral resection (P < 0.001) and any complication (P < 0.001) were independently associated with increased costs. CONCLUSION: Postoperative complications are associated with an increase in mortality, length of hospital stay, and hospital costs. The treatment costs increase with the severity of the postoperative complications. Those factors that are known to increase the treatment costs in pancreatic resection should be considered when planning patients for surgery.
Delivery of Health Care ; Health Care Costs ; Hospital Costs ; Hospital Mortality ; Humans ; Length of Stay ; Mortality ; Multivariate Analysis ; Pancreatectomy ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Postoperative Complications* ; Risk Factors