according to Clavien-Dindo classification, validated in pancreatic surgery. Complications requiring either intervention under general anesthesia or ICU. (LP).
JOP. J Pancreas (Online) 2010 Sep 20; I I (5 Suppl):498-535.
Exocrine Pancreatic Insufficiency After Pancreatic Resection in Patients with Benign or Low Grade Malignant Pancreatic Tumors Pasquali C, Maltese S, Canton SA, Sperti C, Pedrazzoli S Fourth Surgical Clinic, University of Padua. Padua,Italy Context We evaluated the incidence of exocrine pancreatic insufficiency (EPI) after partial pancreatic
(LP). The median follow-up was 77.1 months (range: 24-168 months). Twenty-one out of 88 patients had an
resection
EPI (23.8%). Among the patients receiving a PD, l0 I 12 (83.3%) had an EPI (median follow-up 57.6 months). Among DPPHR, 8/12 (66.6%) developed an EPI (including one with simultaneous LP) with median follow-up of 74.1 months. The CP had 10.0% rate of EPI (l of them received later even a LP) with median follow-up of 80.5 months. Only ll44LP Q.2%) had an
in patients with benign or low grade malignant pancreatic tumors. Objective We reevaluated the clinical and functional data related to exocrine pancreatic frrnction of patients undergoing partial pancreatic resection from 1996 to 2007, with follow-up greater than two years. We excluded patients with chronic pancreatitis or cancff of the exocrine pancreas. Results We performed 342 partial resections of the pancreas (enucleations excluded). Among 99 selected patients with low grade malignant or benign neoplasm, 9 were excluded for follow-up less than two
years and
2 for pre-operative pancreatic exocrine In the remaining 88 patients (46
insufficiency.
neuroendocrine tumors (NET), 25 serous or mucinous cystadenoma (CA), 13 benigrr intraductal tumors (IPNIÌ.} and 4 pseudopapillary cystic tumors (PCT»,
l?had a pancreaticoduodenectomy (PD), 12 duodenum preserving pancreatic head resection (DPPHR), 20 central resections (CR) and 44 left pancreatectomy
EPI (mean follow-up of 79.4 months). Stratified by
disease, we found an EPI 1n 13146NET Q8.2%),4125 (30.7oA), and 0/4 PCT. Among the 21 patients with postoperative EPI, diabetes mellitus was found in only 4 patients (2 DPPHR, I PD,
CA (16.0%), 4ll3 IPMN
I CP), with nonnal preoperative OGTT. In 4 out of 18 patients with EPI who received a PD or DPPHR, a dilated Wirsung was evident at MR/CT. Conclusion The rate of patients with EPI after operations such as PD or DPPHR is from 66Yo to 83%. This fact should be considered in case of resection of the pancreatic head for patients with neoplasms with long life expectancy.
Effect of Surgeon Volume on Outcome Following Pancreaticoduodenectomy in a High-Volume Hospital Pecorelli N, Capretti G, Balzano GrZerbiA, Braga M, Di Carlo V Pancreas Unit, Department of Surgery, IRCCS San Raffaele. Milan, Italy
Context The impact
of
surgeon volume on
(PD) outcome is still So far, available data are from
pancreaticoduodenectomy
controversial.
retrospective multi-institutional reviews, considering in-hospital mortality as the only outcome variable. Objective To assess the independent imFact of surgeon volume on outcome after PD in a single high-volume
institution. Patients and methods Demographics, clinical, and surgical variables were prospectively collected on 610 patients who underwent PD from August 2001 to August 2009. Cut-off value to categorize high and low-volume surgeor§ (IIVS and LVS, respectively) was 18 PD/year. Primary endpoint was operative mortality (death within 30-day postdischarge). Secondary endpoints were morbidity, pancreatic fistula (PF), and length of hospital stay (LOS). Postoperative complications were graded according to Clavien-Dindo classification, validated in pancreatic surgery. Complications requiring either intervention under general anesthesia or ICU
management,
or
causing death were considered
as
major (Clavien-Dindo grade 3b-5). Postoperative PF was defured according to ISGPF definition. Results In the whole series mortalty was 4.lYo, overall morbidity was 61.30À, and PF rate was 27.5%. Two HVS performed 358 PD (58.6%) while six LVS performed 252 PD (41.4%). Morlality was 3.9%o for lfVS and 4.3Yo for LVS E:0.84). Major complication rate was similar for IIVS and LVS (9 .3Yo vs. 9.6%). PF rate was
higher for LVS (32.4% vr. 24.lyo, P:0.03).
Reoperation was necessary :lr,29 (8.1%) patients of the HVS group and in 20 (7.9%) patients of the LVS group (P:0.92). Mean LOS was 15.5 days for IIVS vs. 16.9 days for LVS (P:0.11). At multivariate analysis, risk factors for PF occurrence were LVS, soft pancreatic stump, small duct diameter, and longer operative time. Conclusion Low-volume surgeons had a higher pancreatic fistula rate. However, this did not increase mortality and major complications because of the protective eflect of high-volume hospital.
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JOP. Joumal of the Pancreas
- http://wwwjoplink.net - Vol. I l, No. 5 Supplement -
September 2010.
ISSN
1590-8577]
515
