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Pancreatogastrostomy Vs. Pancreatojejunostomy: a Risk-Stratified Analysis of 5316 Pancreatoduodenectomies

Published on Jan 1, 2018in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-017-3547-2
Brett L. Ecker12
Estimated H-index: 12
(UPenn: University of Pennsylvania),
Matthew T. McMillan17
Estimated H-index: 17
(UPenn: University of Pennsylvania)
+ 32 AuthorsCharles M. Vollmer40
Estimated H-index: 40
(UPenn: University of Pennsylvania)
Abstract
  • References (31)
  • Citations (2)
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References31
Newest
1 CitationsSource
#1Tobias KeckH-Index: 30
#2Ulrich F. WellnerH-Index: 23
Last. U. T. HoptH-Index: 5
view all 36 authors...
107 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 12
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 12 authors...
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.
10 CitationsSource
#1Matthew T. McMillan (Mayo Clinic)H-Index: 17
#2Sameer SoiH-Index: 6
Last. Charles M. VollmerH-Index: 40
view all 27 authors...
Objective:To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator.Background:Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of
46 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...
Abstract Background Pancreatoduodenectomy (PD) is a technically challenging operation characterized by numerous management decisions. Objective This study was designed to test the hypothesis that there is significant variation in the contemporary global practice of PD. Methods A survey with native‐language translation was distributed to members of 22 international gastrointestinal surgical societies. Practice patterns and surgical decision making for PD were assessed. Regions were categorized as...
31 CitationsSource
#1Christopher R. Shubert (Mayo Clinic)H-Index: 9
#2Amy E. Wagie (Mayo Clinic)H-Index: 15
Last. Michael L. Kendrick (Mayo Clinic)H-Index: 45
view all 9 authors...
Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using Internat...
36 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
#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
Cited By2
Newest
#1Maxwell T. Trudeau (UPenn: University of Pennsylvania)
#2Laura Maggino (UPenn: University of Pennsylvania)H-Index: 6
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 9 authors...
Abstract Background Intraoperative drain use for pancreatoduodenectomy (PD) has been practiced in an unconditional, binary manner (placement/no-placement). Alternatively, dynamic drain management has been introduced, incorporating the Fistula Risk Score (FRS) and drain fluid amylase (DFA) analysis, to mitigate clinically-relevant pancreatic fistula (CR-POPF). Study Design An extended experience with dynamic drain management was employed at a single institution for 400 consecutive PDs (2014-2019)...
Source
#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 12
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
Last. Paxton V. Dickson (UTHSC: University of Tennessee Health Science Center)H-Index: 8
view all 26 authors...
Importance Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined. Objective To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype. Design, Setting, and Participants This multinational, retrospective cohort study was condu...
1 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