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Advances in Surgical Management of Pancreatic Diseases

Published on Mar 1, 2016in Gastroenterology Clinics of North America3.366
· DOI :10.1016/j.gtc.2015.10.002
Jashodeep Datta15
Estimated H-index: 15
(UPenn: University of Pennsylvania),
Charles M. Vollmer40
Estimated H-index: 40
(UPenn: University of Pennsylvania)
Sources
Abstract
The surgical management of pancreatic diseases is rapidly evolving, encompassing advances in evidence-driven selection of patients amenable for surgical therapy, preoperative risk stratification, refinements in the technical conduct of pancreatic operations, and quantification of postoperative morbidity. These advances have resulted in dramatic reductions in mortality following pancreatic surgery, particularly at high-volume pancreatic centers. Surgical decision making is complex, and requires an intimate understanding of disease pathobiology, host physiology, technical considerations, and evolving trends. This article highlights key developments in the contemporary surgical management of pancreatic diseases.
  • References (77)
  • Citations (5)
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References77
Newest
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Last. Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 28
view all 29 authors...
Introduction International Study Group of Pancreatic Fistula (ISGPF) grade C postoperative pancreatic fistulas (POPF) are the greatest contributor to major morbidity and mortality following pancreatoduodenectomy (PD); however, their infrequent occurrence has hindered deeper analysis. This study sought to develop a predictive algorithm, which could facilitate effective management of this challenging complication.
41 CitationsSource
#1Robert C.G. Martin (University of Louisville)H-Index: 56
#2David S. KwonH-Index: 10
Last. Kevin Watkins (Cancer Treatment Centers of America)H-Index: 1
view all 8 authors...
Abstract Ablative therapies have been increasingly utilized in the treatment of locally advanced pancreatic cancer (LAPC). Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. We aimed to demonstrate efficacy of treatment with IRE as part of multimodal treatment of LAPC. From July 2010 to October 2014, patients with radiographic stage III LAPC were treated with IRE and monitored under a multicenter, ...
143 CitationsSource
#1Rebecca L. Hoffman (HUP: Hospital of the University of Pennsylvania)H-Index: 7
#2Jenna L. Gates (HUP: Hospital of the University of Pennsylvania)H-Index: 1
Last. Jeffrey A. Drebin (HUP: Hospital of the University of Pennsylvania)H-Index: 21
view all 9 authors...
Background In 2006, the Sendai Consensus Guidelines identified size >3.0 cm as the only independent predictor of malignancy in incidentally discovered pancreatic cysts. The 2012 updated guidelines increased emphasis on radiographic features over size. Earlier studies included patients with preoperatively diagnosed carcinoma or with a corresponding mass. In this report, we characterize the use of size and serum tumor markers in the initial evaluation of pancreatic cystic neoplasms without preoper...
11 CitationsSource
#1Jashodeep Datta (UPenn: University of Pennsylvania)H-Index: 15
#2Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 9
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 17 authors...
Background While contemporary studies demonstrate decreasing complication rates following total pancreatectomy (TP), none have quantified the impact of post-TP complications. The Postoperative Morbidity Index (PMI)—a quantitative measure of postoperative morbidity—combines ACS-NSQIP complication data with severity weighting derived from Modified Accordion Grading System. We establish the PMI for TP in a multi-institutional cohort.
10 CitationsSource
#1Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
#2Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 9
Last. Steven M. Strasberg (UPenn: University of Pennsylvania)H-Index: 32
view all 15 authors...
Objective: The study aim was to quantify the burden of complications of pancreatoduodenectomy (PD). Background: The Postoperative Morbidity Index (PMI) is a quantitative measure of the average burden of complications of a procedure. It is based on highly validated systems—ACS-NSQIP and the Modified Accordion Severity Grading System. Methods: Nine centers contributed ACS-NSQIP complication data for 1589 patients undergoing PD from 2005 to 2011. Each complication was assigned a severity weight ran...
34 CitationsSource
#1Qingqiang Ni (Soochow University (Suzhou))H-Index: 5
#2Lin YunH-Index: 2
Last. Dong Shang (Dalian Medical University)H-Index: 5
view all 4 authors...
The incidence of chronic pancreatitis (CP) is between 2 and 200 per 100,000 persons and shows an increasing trend year by year. India has the highest incidence of CP in the world at approximately 114 to 200 per 100,000 persons. The incidence of CP in China is approximately 13 per 100,000 persons. The aim of this review is to assist surgeons in managing patients with CP in surgical treatment. We conducted a PubMed search for “chronic pancreatitis” and “surgical treatment” and reviewed relevant ar...
10 CitationsSource
#1John A. Stauffer (Mayo Clinic)H-Index: 19
#2Horacio J. Asbun (Mayo Clinic)H-Index: 31
Pancreatic resection is a complex procedure that involves exposure of the retroperitoneal gland, dissection around major vascular structures, and management of an intricate organ, all of which results in a procedure associated with a high morbidity. The application of minimally invasive techniques to pancreatic resection have been studied only relatively recently. This analysis of the current concepts in minimally invasive pancreatic surgery focuses on a select look at currently published series...
22 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 13 authors...
Background A recent randomized, controlled trial investigating intraperitoneal drain use during pancreatoduodenectomy (PD) had a primary goal of assessing overall morbidity. It was terminated early with findings that routine elimination of drains in PD increases mortality and the severity and frequency of overall complications. Here, we provide a follow-up analysis of drain value in reference to clinically relevant postoperative pancreatic fistula (CR-POPF).
44 CitationsSource
#1Amanda B. Cooper (Penn State Milton S. Hershey Medical Center)H-Index: 13
#2Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 12
Last. Henry A. Pitt (TU: Temple University)H-Index: 20
view all 7 authors...
Introduction The impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
45 CitationsSource
#1Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 28
#2Ben L. Zarzaur (UTHSC: University of Tennessee Health Science Center)H-Index: 31
Last. Henry A. Pitt (TU: Temple University)H-Index: 20
view all 6 authors...
Background : Routine drainage of the operative bed following elective pancreatectomy remains controversial. Data specific to distal pancreatectomy (DP) have not been examined in a multi-institutional collaborative.
30 CitationsSource
Cited By5
Newest
#1Roxane D. StaigerH-Index: 3
#2Diana VetterH-Index: 12
Last. P.-A. ClavienH-Index: 97
view all 3 authors...
Reliable reporting of postoperative complications is essential for the assessment and comparison of surgical quality. Postoperative mortality has drastically decreased over the past decades; therefore, focus has shifted toward nonlethal endpoints. Standardized methodologies of complication grading are of paramount importance for such quality assessments. Inconsistent definitions of morbidity and surgical complications have been replaced by various intra- and postoperative complication grading sy...
Source
#1Xianlin HanH-Index: 2
#2Zhiyan XuH-Index: 1
Last. Wenming WuH-Index: 8
view all 5 authors...
2 CitationsSource
#1Laura Maggino (UPenn: University of Pennsylvania)H-Index: 10
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Pancreatic cancer surgery is a continuously evolving field. Despite tremendous advances in perioperative outcomes, pancreatic resection is still associated with substantial morbidity, and mortality is not nil. Institutional caseload is a well-established determinant of patient outcomes, and centralization to experienced centers is essential to the safety and oncological appropriateness of the resection. Minimally invasive approaches are increasingly applied for pancreatic resection, even in canc...
9 CitationsSource
#1Faiz Gani (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
#2Fabian M. Johnston (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 12
Last. Timothy M. Pawlik (OSU: Ohio State University)H-Index: 82
view all 7 authors...
Background Data evaluating the financial implications of volume-based referral are lacking. This study sought to compare in-hospital costs for pancreatic surgery by annual hospital volume.
14 CitationsSource
#1Javier Alvarez-Cienfuegos (University of Navarra)H-Index: 29
#2Joseba Salguero (University of Navarra)H-Index: 2
Last. Fernando Rotellar (University of Navarra)H-Index: 29
view all 11 authors...
Background Laparoscopic organ-sparing pancreatectomy (LOSP) is an ideal therapeutic option in selected cases of pancreatic neuroendocrine tumors (PNETs). Nevertheless, given the low frequency of PNETs, there is scarce evidence regarding short and particularly long-term outcomes of LOSP in this clinical setting.
6 CitationsSource