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Externalized Stents for Pancreatoduodenectomy Provide Value Only in High-Risk Scenarios.

Published on Dec 1, 2016in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-016-3289-6
Matthew T. McMillan17
Estimated H-index: 17
(UPenn: University of Pennsylvania),
Brett L. Ecker12
Estimated H-index: 12
(UPenn: University of Pennsylvania)
+ 9 AuthorsCharles M. Vollmer40
Estimated H-index: 40
(UPenn: University of Pennsylvania)
Abstract
Background Evidence suggests externalized trans-anastomotic stents may be beneficial as a fistula mitigation strategy for pancreatoduodenectomy (PD); however, previous studies have not been rigorously risk-adjusted.
  • References (30)
  • Citations (10)
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References30
Newest
#1Matthew T. McMillan (Mayo Clinic)H-Index: 17
#2Sameer SoiH-Index: 6
Last. Charles M. VollmerH-Index: 40
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46 CitationsSource
#1Jin-Young Jang (SNU: Seoul National University)H-Index: 34
#2YoungHee Chang (SNU: Seoul National University)H-Index: 5
Last. Jin-Seok Heo (SKKU: Sungkyunkwan University)H-Index: 18
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Background There is no consensus on the best method of preventing postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). This multicentre, parallel group, randomized equivalence trial investigated the effect of two ways of pancreatic stenting after PD on the rate of POPF. Methods Patients undergoing elective PD or pylorus-preserving PD with duct-to-mucosa pancreaticojejunostomy were enrolled from four tertiary referral hospitals. Randomization was stratified according to sur...
20 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2John D. Christein (UA: University of Alabama)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 12 authors...
Background Differences in the behavior of postoperative pancreatic fistulas (POPF) have been described after various pancreatic resections. Here, we compare POPFs after pancreatoduodenectomy (PD) and distal pancreatectomy (DP) using the average complication burden (ACB), a quantitative measure of complication burden. Methods From 2001 to 2014, 837 DPs and 1,533 PDs were performed by 14 surgeons at 4 institutions. POPFs were categorized by International Study Group on Pancreatic Fistula standards...
32 CitationsSource
#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
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Giuseppe Malleo (University of Verona)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 5 authors...
31 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Giuseppe Malleo (University of Verona)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
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BACKGROUND: A recent randomized trial used the Fistula Risk Score (FRS) to develop guidelines for selective drainage based on clinically relevant fistula (CR-POPF) risk. Additionally, postoperative day (POD) 1 drain and serum amylase have been identified as accurate postoperative predictors of CR-POPF. This study sought to identify patients who may benefit from selective drainage, as well as the optimal timing for drain removal after pancreatoduodenectomy. STUDY DESIGN: One hundred six pancreato...
44 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
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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
#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
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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
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2John D. Christein (UAB: University of Alabama at Birmingham)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 9 authors...
37 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Background Postoperative pancreatic fistula is a significant contributor to morbidity following proximal and distal pancreatic resections. In recent decades, the incidence of fistula has ranged from 2 to 33 %; however, the consistent identification of risk factors has been difficult due to significant variability in the definition of pancreatic fistula.
33 CitationsSource
Cited By10
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#1Stefano Andrianello (University of Verona)H-Index: 7
#2Giovanni Marchegiani (University of Verona)H-Index: 19
Last. Massimiliano Tuveri (University of Verona)H-Index: 5
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Importance The operative scenarios with the highest postoperative pancreatic fistula (POPF) risk represent situations in which fistula prevention and mitigation strategies have the strongest potential to affect surgical outcomes after pancreaticoduodenectomy. Evidence from studies providing risk stratification is lacking. Objective To investigate whether pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG), both with externalized transanastomotic stent, is the best reconstruction method fo...
1 CitationsSource
#1Thomas F. Seykora (UPenn: University of Pennsylvania)H-Index: 2
#2Laura Maggino (UPenn: University of Pennsylvania)H-Index: 6
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 8 authors...
Recent data illustrates improved outcomes when adhering to early drain removal following pancreatoduodenectomy (PD). This study aims to explore the potential benefits of expanding the timeframe for early drain removal. Six hundred forty PDs were originally managed by selective drain placement and early removal. Outcomes were reappraised in the framework of a novel proposal; intraoperative drains were omitted based on a low-risk profile (Fistula Risk Score 0–2), followed by drain removal at PODs ...
1 CitationsSource
#1Stefano Andrianello (University of Verona)H-Index: 7
#2Giovanni Marchegiani (University of Verona)H-Index: 19
Last. Claudio Bassi (University of Verona)H-Index: 80
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Abstract Background There is wide variability in the use of suture material for pancreatic anastomosis after pancreaticoduodenectomy (PD). This study evaluates the role of suture material on clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticojejunostomy (PJ) in a risk-adjusted setting. Methods A retrospective study comparing (polyester) PE with polydioxanone (PDO) in 520 PDs. Patients were matched for risk for CR-POPF according to the fistula risk score (FRS) with th...
2 CitationsSource
#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 12
#2Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 4 authors...
Background Improvements in surgical outcomes are predicated on recognizing effective practices with subsequent adaptation. It is unknown whether risk assessment for pancreatic fistula (clinically relevant postoperative pancreatic fistula [CR-POPF]) after pancreaticoduodenectomy (PD) translates to improved patient outcomes at the practice level. Study design A prospectively collected, single-surgeon career experience (2003 to 2018) of 455 consecutive pancreatectomies (303 PDs and 152 distal pancr...
3 CitationsSource
#1Lois A. Daamen (UU: Utrecht University)H-Index: 5
#2F. Jasmijn Smits (UU: Utrecht University)H-Index: 4
Last. Quintus Molenaar (UU: Utrecht University)H-Index: 22
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Abstract Background Many pancreatic anastomoses have been proposed to reduce the incidence of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, but a complete overview is lacking. This systematic review and meta-analysis aims to provide an online overview of all pancreatic anastomosis techniques and to evaluate the incidence of clinically relevant POPF in randomized controlled trials (RCTs). Methods A literature search was performed to December 2017. Included were studies givi...
6 CitationsSource
#1Priya M. Puri (UPenn: University of Pennsylvania)H-Index: 3
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Postoperative pancreatic fistula (POPF) is the most common complication after major pancreatic resections and is the greatest contributor to postoperative morbidity and mortality following pancreatoduodenectomy (PD). The relatively recent establishment of a standardized definition of POPF by the International Study Group of Pancreatic Fistula (ISGPF) allowed for the delineation between innocuous biochemical POPF (grade A) and clinically relevant (CR) POPF (grades B and C). This classification sy...
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#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 12
#2Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
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#1Camilo Correa-Gallego (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 19
#2Peter J. Allen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 68
As recently as 30 years ago, major pancreatic resections were associated with morbidity and mortality rates that were considered prohibitive by many. Over the last several decades, through better training, technical advances, and the development of intensive perioperative care and interventional endoscopy and radiology, these procedures have become significantly safer. Pancreaticoduodenectomy is now associated with postoperative mortality as low as 1% in many high-volume centers.
Source
#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
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Giuseppe Malleo (University of Verona)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 7 authors...
Abstract Introduction Clinically relevant postoperative pancreatic fistula (CR-POPF) is a morbid complication following pancreatoduodenectomy (PD). It is unclear how pancreatic surgeons perceive risk for this complication, and the implications thereof. Methods A web-based survey was distributed to members of 22 international GI surgical societies. CR-POPF risk factors were categorized as follows: (i) patient factors, (ii) pancreatic gland characteristics, (iii) intraoperative variables, (iv) per...
7 CitationsSource