Luca Morelli1,2,3, Gregorio Di Franco4, Simone Guadagni4, Matteo Palmeri4, Niccolò Furbetta4, Desirée Gianardi4, Marco Del Chiaro5, Giulio Di Candio4, Franco Mosca6. 1. General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy. luca.morelli@unipi.it. 2. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy. luca.morelli@unipi.it. 3. General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy. luca.morelli@unipi.it. 4. General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy. 5. Pancreatic Surgery Unit, Department of Clinical Science, Intervention and Technology, Karolinska Institutet MCC, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 6. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
Abstract
BACKGROUND: The treatment of pancreatic stump is a critical step of pancreatoduodenectomy (PD) because leaks from this anastomosis incur major morbidity and mortality. We describe the technical details of a modified end-to-side pancreatojejunostomy (mPJ), and report on the outcome of the first 100 patients. METHODS: From October 2008 to June 2017, 424 pancreatic resections were performed, of which 203 were PD. The mPJ was introduced in November 2010 and used in 100 consecutive patients, by a single surgeon. Data were retrieved from a prospectively collected Institutional database, and used for the present retrospective evaluation. Post-operative pancreatic fistulas (POPF) were stratified with the Fistula Risk Score (FRS), based on the 2005-International Study Group of Pancreatic Fistula classification (ISGPFc) and on the subsequent 2016-revised version (ISGPSc). RESULTS: ISGPFc POPF occurred in 17/100 (17%): grade A in 10/100 (10%), grade B in 6/100 (6%) and grade C in 1/100 (1%). On the ISGPSc, POPF rate averaged 7%: grade B in 6/100 (6%) and grade C in 1/100 (1%). POPF rate associated with high FRS was 18.8%/6.3% (ISGPFc/ISGPSc). With low and intermediate FRS, POPFs were 5.3%/0% (ISGPFc/ISGPSc) and 21.3%/9.8% (ISGPFc/ISGPSc) respectively. Re-operation rate was 3%. In-hospital mortality rate was 2% and specific mortality rate for POPF was 1%. CONCLUSIONS: The mPJ technique is associated with a POPF rate which was less than expected, especially for "difficult" pancreas with high FRS (soft gland texture and small duct). A larger prospective series is needed in addition to comparative studies with other techniques for robust assessment.
BACKGROUND: The treatment of pancreatic stump is a critical step of pancreatoduodenectomy (PD) because leaks from this anastomosis incur major morbidity and mortality. We describe the technical details of a modified end-to-side pancreatojejunostomy (mPJ), and report on the outcome of the first 100 patients. METHODS: From October 2008 to June 2017, 424 pancreatic resections were performed, of which 203 were PD. The mPJ was introduced in November 2010 and used in 100 consecutive patients, by a single surgeon. Data were retrieved from a prospectively collected Institutional database, and used for the present retrospective evaluation. Post-operative pancreatic fistulas (POPF) were stratified with the Fistula Risk Score (FRS), based on the 2005-International Study Group of Pancreatic Fistula classification (ISGPFc) and on the subsequent 2016-revised version (ISGPSc). RESULTS: ISGPFc POPF occurred in 17/100 (17%): grade A in 10/100 (10%), grade B in 6/100 (6%) and grade C in 1/100 (1%). On the ISGPSc, POPF rate averaged 7%: grade B in 6/100 (6%) and grade C in 1/100 (1%). POPF rate associated with high FRS was 18.8%/6.3% (ISGPFc/ISGPSc). With low and intermediate FRS, POPFs were 5.3%/0% (ISGPFc/ISGPSc) and 21.3%/9.8% (ISGPFc/ISGPSc) respectively. Re-operation rate was 3%. In-hospital mortality rate was 2% and specific mortality rate for POPF was 1%. CONCLUSIONS: The mPJ technique is associated with a POPF rate which was less than expected, especially for "difficult" pancreas with high FRS (soft gland texture and small duct). A larger prospective series is needed in addition to comparative studies with other techniques for robust assessment.
Authors: Claudio Bassi; Giovanni Marchegiani; Christos Dervenis; Micheal Sarr; Mohammad Abu Hilal; Mustapha Adham; Peter Allen; Roland Andersson; Horacio J Asbun; Marc G Besselink; Kevin Conlon; Marco Del Chiaro; Massimo Falconi; Laureano Fernandez-Cruz; Carlos Fernandez-Del Castillo; Abe Fingerhut; Helmut Friess; Dirk J Gouma; Thilo Hackert; Jakob Izbicki; Keith D Lillemoe; John P Neoptolemos; Attila Olah; Richard Schulick; Shailesh V Shrikhande; Tadahiro Takada; Kyoichi Takaori; William Traverso; Charles R Vollmer; Christopher L Wolfgang; Charles J Yeo; Roberto Salvia; Marcus Buchler Journal: Surgery Date: 2016-12-28 Impact factor: 3.982
Authors: Matthew T McMillan; Sameer Soi; Horacio J Asbun; Chad G Ball; Claudio Bassi; Joal D Beane; Stephen W Behrman; Adam C Berger; Mark Bloomston; Mark P Callery; John D Christein; Elijah Dixon; Jeffrey A Drebin; Carlos Fernandez-Del Castillo; William E Fisher; Zhi Ven Fong; Michael G House; Steven J Hughes; Tara S Kent; John W Kunstman; Giuseppe Malleo; Benjamin C Miller; Ronald R Salem; Kevin Soares; Vicente Valero; Christopher L Wolfgang; Charles M Vollmer Journal: Ann Surg Date: 2016-08 Impact factor: 12.969
Authors: Shailesh V Shrikhande; Masillamany Sivasanker; Charles M Vollmer; Helmut Friess; Marc G Besselink; Abe Fingerhut; Charles J Yeo; Carlos Fernandez-delCastillo; Christos Dervenis; Christoper Halloran; Dirk J Gouma; Dejan Radenkovic; Horacio J Asbun; John P Neoptolemos; Jakob R Izbicki; Keith D Lillemoe; Kevin C Conlon; Laureano Fernandez-Cruz; Marco Montorsi; Max Bockhorn; Mustapha Adham; Richard Charnley; Ross Carter; Thilo Hackert; Werner Hartwig; Yi Miao; Michael Sarr; Claudio Bassi; Markus W Büchler Journal: Surgery Date: 2016-12-24 Impact factor: 3.982