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*

ICG is widely applied in real-time imaging during abdominal surgery, plastic surgery, as well as oncologic staging and treatment. A twenty-eight year-old female patient was found to have a 4.5 cm solid pseudopapillary neoplasm in the tail of the pancreas. Under ICG-fluorescent pancreatic perfusion-guidance, we easily defined the margin of the pancreatic tumor and secured the resection margin when performing laparoscopic distal pancreatosplenectomy in the patient. No clinically relevant complications, including postoperative pancreatic fistula, were noted. Intravenous ICG can be very easily and quickly detected in the pancreas under near infrared light. This enhanced vision gives strong contrast to the organ compared to a necrotic tumor with poor blood perfusion, such as solid pseudopapillary neoplasm. Based on our current experience, ICG pancreatic perfusion-guided determination of appropriate resection margin is useful and feasible during pancreaticoduodenectomy.
Female ; Fluorescent Dyes ; Humans ; Indocyanine Green ; Pancreas* ; Pancreatectomy ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Perfusion ; Surgery, Plastic ; Tail

OBJECTIVETo evaluate the feasibility and safety of laparoscopic pancreaticoduodenectomy(LPD).

METHODSData of 66 patients from Sir Run Run Shaw Hospital undergoing LPD from September 2012 to September 2014 were reviewed. There were 44 male and 22 female with the mean age of (58.7±10.3) years and mean body mass index of (23.5±3.9)kg/m(2). Forty-five patients presented the symptoms and four of all had the history of abdominal surgery, including 2 cases of laparoscopic pancreatic surgery.

RESULTSOf 66 patients underwent laparoscopic procedure, 1 patient underwent LPD combined with right hepatic resection, 1 patient underwent laparoscopic distal gastrectomy with LPD, and 1 patient underwent LPD after laparoscopic distal pancreatectomy. The mean operative time was (367±49) minutes. The mean blood loss was(193±126)ml. The rate of overall postoperative complications was 36.4%(24/66), with 4.5%(3/66) of B or C pancreatic fistula and 7.6% (5/66) of bleeding. The mean postoperative hospital stay was (18.9±12.1) days. Mean tumor size was (3.8±2.3) cm, and the mean number of lymph nodes harvested was (20.3±10.9). Forty-severn patients were diagnosed as pancreatic adenocarcinoma(n=18), cholangiocarcinoma(n=7), ampullary adenocarcinoma(n=21), and gastric cancer(n=1), respectively.

CONCLUSIONLPD is feasible and safe under the skilled hand.

Adenocarcinoma ; surgery ; Aged ; Anastomosis, Surgical ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Pancreatectomy ; Pancreatic Fistula ; pathology ; Pancreatic Neoplasms ; surgery ; Pancreaticoduodenectomy ; Postoperative Complications

OBJECTIVETo develop and test a scoring system to predict the risks of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy(PD).

METHODSClinic data and postoperative complications of the 445 consecutive patients who underwent a PD procedure between January 2008 and April 2015 in Peking University First Hospital were retrospectively collected and analyzed.The patients were randomly selected to modelling and validation sets at a ratio of 3∶1, respectively.The patient data were subjected to univariate and multivariate analysis in the modelling set of patients.A score predictive of POPF was designed and tested in the validation set.

RESULTSPOPF occurred in 88 of 334 patients(26.4%) in the modelling set.The multivariate analysis showed that body mass index (BMI, P<0.01) and pancreatic duct width(P=0.001) are associated with POPF independently.A risk score to predict POPF was constructed based on these factors and successfully tested.The area under the receiver operating characteristic curve were 0.829(95% CI: 0.777-0.881) on the modelling set and 0.885(95% CI: 0.825-0.945) on the validation set, respectively.

CONCLUSIONSBMI and pancreatic duct width were associated with POPF after PD. The preoperative assessment of a patient's risk for POPF is feasible.The present risk score is a valid tool to predict POPF in patients undergoing PD, to make the selection on anastomosis types, and to take precautions against POPF.

Anastomosis, Surgical ; Body Mass Index ; Humans ; Intestines ; surgery ; Multivariate Analysis ; Pancreas ; pathology ; surgery ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; pathology ; Pancreaticoduodenectomy ; adverse effects ; Postoperative Complications ; Postoperative Period ; ROC Curve ; Retrospective Studies ; Risk Factors

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

OBJECTIVETo investigate the effect of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy on the early curative effect after pancreaticoduodenectomy (PD).

METHODSThe study was a prospective controlled trial. A total of 219 patients undergoing PD from January 2010 to March 2013 were randomly divided into external drainage group (n = 110) and internal drainage group (n = 109). The pancreatic duct stent was put in the jejunum during the operation in the internal drainage group, while that in the external drainage group was placed outside the body through the jejunum and abdominal wall. The intra-operative blood loss, operative duration, post-operative hospital stay, mortality rate, and the morbidity of pancreatic fistula as well as other complications were compared between the two groups.

RESULTSCompared with internal drainage group, pancreatic duct stent external drainage obviously reduced the morbidity of pancreatic fistula (13.6% vs. 22.6%), delayed gastric emptying (10.0% vs. 27.5%), abdominal infection (6.4% vs. 19.3%), intestinal obstruction (8.2% vs. 20.2%) along with the overall complications (24.5% vs. 41.3%) after PD (χ(2) = 5.735 8 to 11.047 7, P < 0.05), and shortened the healing duration of pancreatic fistula ((11.5 ± 2.9) d vs. (20.1 ± 5.7) d, t = 5.07, P < 0.01), while there was no significant difference in the intra-operative blood loss, operative duration, post-operative hospital stay and mortality rate, etc between the two groups (P > 0.05).

CONCLUSIONSPancreatic duct stent external drainage can effectively reduce the morbidity of pancreatic fistula and the overall complications after PD, which is safe and feasible. The method is worthy of popularization and application clinically.

Adult ; Aged ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; surgery ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreaticoduodenectomy ; Postoperative Complications ; prevention & control ; Prospective Studies ; Treatment Outcome

OBJECTIVETo analyze the perioperative complications and recent results of the Frey procedure in the treatment of chronic pancreatitis.

METHODSBetween February 2009 and September 2012, 104 patients with chronic pancreatitis underwent the Frey procedures. This study included 91 male and 13 female patients, with a mean age of (49 ± 11) years (range, 16 to 75 years). The most common symptoms were abdominal pain in 97 patients, diarrhea in 10 patients, obstructive jaundice in 5 patients, and 5 patients had no symptoms. Nine patients had history of pancreatic surgery.

RESULTSThere was no mortality. Perioperative complications occurred in 25 patients (24.0%), included pancreatic fistula in 7 patients, delayed gastric emptying in 15 patients, bleeding in 2 patients, abdominal infection in 1 patient, pulmonary infection in 2 patients, delayed healing incision in 4 patients, and pancreatic pseudocyst in 1 patient with reoperation. Seventeen patients with preoperative hyperamylasemia had a higher risk of intranperative hemorrhea and perioperative complications rates. At a mean follow-up of (29 ± 13) months, 8 patients had missed, 2 patients had died, and 3 patients was proved to be coexisted with pancreatic carcinoma. Among 87 patients with abdominal pain, 58 patients (66.7%) have complete pain relief and 23 patients (26.4%) have substantial pain relief. However, among 5 patients without abdominal pain, 2 had recurrent abdominal pain now. Seven of 17 patients with diabetes mellitus aggravated, and new onset of diabetes mellitus was observed in 10 patients. In addition, impaired glucose tolerance was developed in 13 patients. Among 10 patients with diarrhea, the symptom of 4 patients got worse. Thirty-one patients (33.7%) newly developed exocrine insufficiency, included 12 patients treated by patients oral administration of pancreatin and 19 patients only treated by diet control. Ten patients was readmitted and 5 patients underwent reoperation, included 1 patient of pancreatic pseudocyst, 3 patients of chronic pancratitis coexisted with pancreatic carcinoma, and 1 patient of chronic pancratitis with abdominal pain and obstructive jaundice.

CONCLUSIONSFrey procedure in the treatment of chronic pancreatitis is a safe technique with low mortality and morbidity rates, but indication should be strictly controlled and pancreatic tumorigenesis should be alerted.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreatic Fistula ; epidemiology ; Pancreaticojejunostomy ; Pancreatitis, Chronic ; surgery ; Postoperative Complications ; epidemiology ; Treatment Outcome ; Young Adult

OBJECTIVETo study the application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.

METHODSSix cases of cystic carcinoma in the pancreatic body and tail treated between Nov, 2009 and Mar, 2011 were retrospectively analyzed. The original image data of 64-slice spiral CT were collected and using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted to obtain the 3-dimensional reconstruction images with customized image manipulation software. The specific surgical approach (the trocar position) and surgical procedure were planned based on the reconstructed mode.

RESULTSThe reconstructed 3-dimensional model clearly displayed cystic carcinoma in the pancreatic body and tail and the adjacent organs, showing distinct relationship between the cystoma and the splenic artery and vein. All the patients successfully underwent laparoscopic resection of the pancreatic body and tail without perioperative death. The spleen was preserved in 5 cases and removed in 1 case due to mucinous cystadenocarcinoma. The overall rate of pancreatic fistulae was 33.3% without incidences of postoperative hemorrhage. The average hospital stay of the patients was 12 days.

CONCLUSIONThree-dimensional reconstruction based on pancreatic CT data provides valuable assistance for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.

Adult ; Aged ; Computer Simulation ; Cystadenocarcinoma, Mucinous ; diagnostic imaging ; surgery ; Cystadenoma, Mucinous ; diagnostic imaging ; surgery ; Cystadenoma, Serous ; diagnostic imaging ; surgery ; Female ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; surgery ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Fistula ; etiology ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Retrospective Studies ; Spleen ; surgery ; Tomography, Spiral Computed

Pancreaticoduodenectomy(PD) has been widely accepted as one of the most complicated operation in abdominal surgery. The patients who receive PD operation always have other concurrent conditions, such as jaundice, diabetes, liver dysfunction, and malnutrition. Pancreatic fistula, biliary fistula and gastrointestinal dysfunction are common complications after PD. Proper perioperative management and fluid administration can reduce postoperative complications and the mortality.
Anastomosis, Surgical ; Drainage ; Fluid Therapy ; Humans ; Nutritional Support ; Pancreatic Fistula ; surgery ; therapy ; Pancreaticoduodenectomy ; Postoperative Complications ; prevention & control

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Female ; Humans ; Male ; Mesenteric Veins/radiography ; Pancreas/abnormalities ; Pancreatic Diseases/*diagnosis/therapy ; Pancreatic Fistula/etiology ; Pancreatic Neoplasms/diagnosis/surgery ; Pancreaticoduodenectomy/adverse effects ; Portal Vein/radiography ; Splenic Vein/radiography ; Tomography, X-Ray Computed