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Intra-abdominal drainage following pancreatic resection:A systematic review

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World Journal of Gastroenterology 2015年第40期21卷 11458-11468页

作者： Filip Cecka Martin Lovecek Bohumil Jon Pavel Skalicky Zdeněk Subrt Cestmír Neoral Alexander Ferko Department of Surgery Medical Faculty and University Hospital Hradec Králové First Department of Surgery Medical Faculty and University Hospital Olomouc Department of Field Surgery Military Health Science Faculty Hradec KrálovéDefence University Brno

AIM: To study all the aspects of drain management in pancreatic ***: We conducted a systematic review according to the PRISMA guidelines. We searched the Cochrane Central Registry of Controlled Trials,EMBASE,Web of Science,and Pub Med(MEDLINE) for relevant articles on drain management in pancreatic surgery. The reference lists of relevant studies were screened to retrieve any further studies. We included all articles that reported clinical studies on human subjects with elective pancreatic resection and that compared various strategies of intra-abdominal drain management,such as drain vs no drain,selective drain use,early vs late drain extraction,and the use of different types of drains. RESULTS: A total of 19 studies concerned with drain management in pancreatic surgery involving 4194 patients were selected for this systematic review. We included studies analyzing the outcomes of pancreatic resection with and without intra-abdominal drains,studies comparing early vs late drain removal and studies analyzing different types of drains. The majority of the studies reporting equal or superior results for pancreatic resection without drains were retrospective and observational with significant selection bias. One recent randomized trial reported higher postoperative morbidity and mortality with routine omission of intraabdominal drains. With respect to the timing of drain removal,all of the included studies reported superior results with early drain removal. Regarding the varioustypes of drains,there is insufficient evidence to determine which type of drain is more suitable following pancreatic resection. CONCLUSION: The prophylactic use of drains remains controversial. When drains are used,early removal is recommended. Further trials comparing types of drains are ongoing.

关键词： Pancreas pancreatic resection Pancrea-tectomy Drainage pancreatic fistula

Influence of the body mass index on postoperative outcome and long-term survival after pancreatic resections in patients with underlying malignancy

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Hepatobiliary Surgery and Nutrition 2019年第3期8卷 201-210页

作者： Philippa Seika Fritz Klein Uwe Pelzer Johann Pratschke Marcus Bahra Thomas Malinka Department of Surgery Charite Campus Mitte and Charite Campus Virchow KlinikumCharité-Universitatsmedizin BerlinBerlinGermany Department of Hematology/Oncology/Tumorimmunology Campus Virchow KlinikumCharité-Universitatsmedizin BerlinBerlinGermany

Background:While the long-term survival rate among patients with pancreatic and periampullary carcinomas remains low,it can be influenced by various *** purpose of this retrospective study was to investigate the effects of body mass index(BMI)on postoperative complications and patient survival after pancreatic resections for underlying malignancy over a 20-year observation ***:We analyzed 1,384 patients,918 patients with pancreatic ductal adenocarcinoma(PDAC)(66.3%),229 patients with distal cholangiocarcinoma(16.5%),206 ampullary carcinoma patients(14.8%),and 31 duodenal carcinoma patients(2.2%).Patients were classified into four groups(group 130.0)according to their BMI(kg/m2).We analyzed differences in postoperative complications,postoperative length of hospital stays,reoperations,postoperative mortality and survival rate among the ***:Within a mean observation period of 687.7[2–8,500]days,735(53.1%)patients *** were important differences in postoperative complications(group 1,16.2%;group 2,20.3%;group 3,27.2%,group 4,41.6%)with the type of postoperative complications also varying between the *** 1-,5-,10-and 15-year survival rates were 66.4%,25.5%,17.9%,and 12.1%,respectively,with survival rates varying amongst the four ***:Patients with a BMI between 18.5 and 30 show better postoperative outcomes,regarding complications,hospitalization duration,and reoperation rates than underweight or obese ***-term survival depends strongly on postoperative complications while patients with a higher BMI show better long-term survival rates.

关键词： pancreatic resection body mass index(BMI) outcome long-term survival

Natural orifice transluminal endoscopic surgery in pancreatic diseases

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World Journal of Gastroenterology 2010年第31期16卷 3859-3864页

作者： Sonja Gillen Jrg Kleeff Michael Kranzfelder Shailesh V Shrikhande Helmut Friess Hubertus Feussner Department of Surgery Tech-nische Universitt München Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery Tata Memorial Hospital

Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that has received considerable interest in recent years. Although minimal access surgery has increasingly replaced traditional open abdominal surgical approaches for a wide spectrum of indications, in pancreatic diseases its widespread use is limited to few indications because of the challenging and demanding nature of major pancreatic operations. Nonetheless, there have been attempts in animal models as well as in the clinical setting to perform diag- nostic and resectional NOTES for pancreatic diseases. Here, we review and comment upon the available data regarding currently analyzed and performed pancreatic NOTES procedures. Potential indications for NOTES include peritoneoscopy, cyst drainage, and necrosectomy, palliative procedures such as gastroenterostomy, as well as resections such as distal pancreatectomy or enucleation. These procedures have already been shown to be technically feasible in several studies in animal models and a few clinical trials. In conclusion, NOTES is a rapidly developing concept/technique that could potentially become an integral part of the armamentarium dealing with surgical approaches to pancreatic diseases.

关键词： Natural orifice transluminal endoscopic surgery pancreatic disease Chronic pancreatitis pancreatic resection pancreatic drainage

pancreatic cancer: Advances in treatment

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World Journal of Gastroenterology 2014年第28期20卷 9354-9360页

作者： Somala Mohammed George Van Buren Ⅱ William E Fisher The Elkins Pancreas Center Michael E DeBakey Department of Surgeryand Dan L Duncan Cancer CenterBaylor College of Medicine

pancreatic cancer is a leading cause of cancer mortality and the incidence of this disease is expected to continue *** patients with pancreatic cancer have traditionally faced a dismal prognosis,over the past several years various advances in diagnosis and treatment have begun to positively impact this *** of effective combinations of existing chemotherapeutic agents,such as the FOLFIRINOX and the gemcitabine+nab-paclitaxel regimen,has improved survival for selected patients although concerns regarding their toxicity profiles remain.A better understanding of pancreatic carcinogenesis has identified several pre-malignant precursor lesions,such as pancreatic intraepithelial neoplasias,intraductal papillary mucinous neoplasms,and cystic *** technology has also evolved dramatically so as to allow early detection of these lesions and thereby facilitate earlier *** remains a cornerstone of treatment for patients with resectable pancreatic tumors,and advances in surgical technique have allowed patients to undergo resection with decreasing perioperative morbidity and *** has also become feasible in selected patients with borderline resectable tumors as a result of neoadjuvant ***,pancreatectomy involving vascular reconstruction and pancreatectomy with minimally invasive techniques have demonstrated safety without significantly compromising oncologic ***,a deeper understanding of molecular aberrations contributing to the development of pancreatic cancer shows promise for future development of more targeted and safe therapeutic agents.

关键词： pancreatic cancer pancreaticoduodenectomy Treatment advances pancreatic oncology Chemotherapy FOLFIRINOX pancreatic resection

Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas

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World Journal of Gastroenterology 2014年第37期20卷 13402-13411页

作者： Bergthor Bjrnsson Per Sandstrm Department of Surgery County Council of stergtland and Department of Clinical and Experimental MedicineFaculty of Health SciencesLinkping University

Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP.

关键词： Adenocarcinoma of the pancreas Laparoscopy Distal pancreatectomy Surgical margins pancreatic resection

Emerging concepts in the management of pancreatic ductal adenocarcinoma

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Laparoscopic, Endoscopic and Robotic Surgery 2019年第4期2卷 83-88页

作者： Sanket Srinivasa Rowan Parks HPB Surgery Royal Infirmary of EdinburghEdinburghUK Department of Clinical Surgery University of EdinburghEdinburghUK

pancreatic ductal adenocarcinoma is characterised by poor oncological outcomes with curative treatment only possible for a *** are dependent on the stage of the disease and location within the pancreas with constitutional decline often *** require biochemical investigations and accurate imaging with CT to determine stage of disease and local ***-PET and endoscopic ultrasound are increasingly used *** remains the cornerstone of curative management and can be performed using minimally invasive *** resection and combination treatment with chemoradiotherapy are also utilised for suitable *** outcomes may be optimised using enhanced recovery *** standards have been defined for individual clinicians and units to benchmark their clinical *** developments described hold promise in improving outcomes from pancreatic ductal adenocarcinoma.

关键词： pancreatic ductal adenocarcinoma pancreatic resection Laparoscopic surgery Robotic surgery

A review of the current evidence for the role of minimally invasive pancreatic surgery following neo-adjuvant chemotherapy

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第2期5卷 47-51页

作者： Francis P.Robertson Rowan W.Parks Department of Hepatobiliary and Transplant Surgery Freeman HospitalNewcastleUnited Kingdom Department of Clinical Surgery Royal Infirmary of EdinburghEdinburghUnited Kingdom Division of Surgical and Interventional Science Royal Free CampusUniversity College LondonLondonUnited Kingdom

Objective:Surgical resection of pancreatic cancer remains the only potentially curative treatment for pancreatic ductal *** robotic platform has been introduced to surgical practice and recent large studies from national registries have demonstrated similar or improved peri-operative outcomes compared to the standard open ***-adjuvant chemotherapy is increasingly being offered to patients with borderline resectable/locally advanced disease but this has led to more challenging *** of patients undergoing minimally invasive resection following neo-adjuvant chemotherapy remain *** aim of this review is to assess the current evidence for the peri-operative safety and long-term oncological outcomes associated with minimally invasive pancreatic resection following neo-adjuvant ***:Medline,Embase and Cochrane Central Register for Clinical Trials were searched up until 31st October *** search terms include“minimally invasive”,“robotic”,“laparoscopic”,“pancreatectomy”,“pancreatic resection”,“whipple's pancreaticoduodenectomy”,“distal pancreatectomy”,“chemotherapy”,“neo-adjuvant chemotherapy”,“radiotherapy”,“neo-adjuvant chemoradiotherapy”,“induction therapy”,and“conversion surgery”.All studies including patients undergoing pancreatic resections were *** which did not clearly state the approach to resection(minimally invasive or open)were ***:Seventy-eight studies were identified of which 8 compared open and minimally invasive resection following neo-adjuvant *** was insufficient data to perform a *** surgery was associated with lower blood loss and shorter length of hospital ***-year overall survival rates were similar between patients who underwent robotic or open resection however the robotic approach was associated with higher lymph node yield and a lower R1 resection ***:Currently the evidence for minimally invasive surgery foll

关键词： pancreatic resection Minimally invasive Robotic Neo-adjuvant chemotherapy

pancreatic cancer–Surgery for recurrent disease

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The Chinese-German Journal of Clinical Oncology 2007年第2期6卷 159-161页

作者： Carolin Reiser Jrg Kleeff Helmut Friess Markus Büchler Department of General Surgery University of Heidelberg Im Neuenheimer Feld 110 69120 Heidelberg Germany

Recurrence of pancreatic ductal adenocarcinoma （PDAC） after a resection with curative intent is inevitable in the majority of cases. Approximately three-quarters of patients ultimately die from metastatic, local, or combined tumor recurrence . This may be due to the insufficient control over the disease after resecting the tumor and/or the existence of micrometastases at the time of the initial diagnosis. Even multimodality approaches including surgery, neoadjuvant radio-chemotherapy, adjuvant therapy, and novel targeted therapies offer only limited benefit and are not able to prevent recurrence in most of the patients.

关键词： recurrent disease survival pancreatic cancer surgery pancreatic resection morbidity mortality