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Missed Pancreaticobiliary malignancy: The Flaw of the Expedited Cholecystectomy

Surgical Science 2024年第7期15卷 451-464页

作者： Dylan S. Goto Larissa Fujii-Lau Linda L. Wong Department of Surgery John A. Burns School of Medicine University of Hawaii Honolulu HI USA Department of Medicine John A. Burns School of Medicine University of Hawaii Honolulu HI USA

Background: Early cholecystectomy has been recommended for patients with acute cholecystitis and gallstone pancreatitis. However, patients with pancreaticobiliary malignancy may present acutely with similar symptoms. We hypothesize that the diagnoses of these malignancies may potentially be delayed as an unintended consequence of expedited cholecystectomies. This study reviews a cohort of patients who underwent pancreaticoduodenectomy (PD) to identify those who underwent a separate cholecystectomy before their PD. Methods: We retrospectively reviewed 162 PDs performed between 2012 and 2022. Data collected included: demographics, disease etiology and the presence of cholelithiasis. We identified patients who had a previous cholecystectomy and the time elapsed before PD as well as procedures done during the interval. We reported detailed case summaries on those patients who had a cholecystectomy within 1 year of PD. Results: In the entire cohort, mean age was 65 years, 54% were males, and 83% had a malignant reason for PD. Thirty-one patients had cholelithiasis with 23 (14%) patients having had previous cholecystectomy. Six patients had cholecystectomy within 1 year of PD. They had the following malignancies: ampullary—3, pancreas—1, cholangiocarcinoma—1 and neuroendocrine—1. Four of these patients had expedited cholecystectomy on their index hospital admission and were later found to have a periampullary malignancy with further work up. Conclusions: Pancreaticobiliary malignancies can be difficult to diagnose, and surgeons should not overlook these potential diagnoses when considering expedited cholecystectomy. Future studies in large cohorts are needed to identify high risk candidates who should undergo more detailed testing to exclude malignancy before proceeding with cholecystectomy.

关键词： Cholecystectomy periampullary malignancy Pancreas malignancy Pancreaticoduodenectomy

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Prognostic Value of ALP and LDH in periampullary Carcinoma Patients Undergoing Surgery

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Current Medical Science 2022年第1期42卷 150-158页

作者： Chao DANG Yun-hua DENG Ren-yi QIN Department of Pancreatic-Biliary Surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Dermatology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Objective:Conversion of normal cells to cancer cells is often accompanied by abnormal synthesis of serum *** alkaline phosphatase(ALP)and lactate dehydrogenase(LDH)have been reported to have prognostic value in a variety of *** aim of this study was to investigate the effect of preoperative serum ALP and LDH levels on the prognosis of patients with periampullary carcinoma who underwent pancreatoduodenectomy(PD).

关键词： periampullary malignancy pancreatoduodenectomy alkaline phosphatase lactate dehydrogenase prognostic value

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A new approach for Roux-en-Y reconstruction after pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 649-653页

作者： Meng Xu Min Wang Feng Zhu Rui Tian Cheng-Jian Shi Xin Wang Ming Shen Ren-Yi Qin Department of Pancreatic-Biliary Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

BACKGROUND： Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy （PD） and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. In this study, we introduced a new technical approach, a modified Roux-en-Y reconstruction and evaluated its safety and feasibility. METHODS： We retrospectively reviewed the patients who had undergone PD with the modified Roux-en-Y reconstructive technique for periampullary malignancies from January 2011 to June 2012. The data on complications, hospital stay and outcomes after the modified Roux-en-Y reconstruction were analyzed. RESULTS： The reconstruction was performed in 171 patients, of whom 92 received pancreaticogastrostomy and 79 received pancreaticojejunostomy. The median duration of surgery was 4.0 hours （range 3.1-6.9） in all patients, and the median blood loss was 530 mL （range 200-2000）. Sixty-nine patients were subjected to transfusions, with a median transfusion volume of 430 mL （range 200-1400）. The median hospital stay of the patients was 14 days （range 11-38）. Their operative mortality was zero and overall morbidity was 18.1% （31 patients）. Only four patients （2.3%） developed pancreatic fistulas （grade A fistulas in two patients and grade B in two patients）; no patients developed grade C fistula. None of the patients developed bile reflux gastritis. CONCLUSIONS： The modified Roux-en-Y reconstruction, which isolates biliary anastomosis from pancreatic, gastric or jejunalanastomosis, is a safe, reliable, and favorable technique. But it needs further investigation in randomized controlled trials.

关键词： Roux-en-Y reconstruction postoperative complications pancreatic fistula periampullary malignancy

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