Defining the practice of pancreatoduodenectomy around the world

Published on Dec 1, 2015in Hpb3.401
· DOI :10.1111/HPB.12475
Matthew T. McMillan23
Estimated H-index: 23
(UPenn: University of Pennsylvania),
Giuseppe Malleo43
Estimated H-index: 43
(University of Verona)
+ 2 AuthorsCharles M. Vollmer67
Estimated H-index: 67
(UPenn: University of Pennsylvania)
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 North America, South/Central America, Asia/Australia, and Europe/Africa/Middle East. Results Surveys were completed by 897 surgeons, representing six continents and eight languages. The median age and length of experience of respondents were 45 years and 13 years, respectively. In 2013, surgeons performed a median of 12 PDs and reported a median career total of 80 PDs; only 53.8% of respondents had surpassed the number of PDs considered necessary to surmount the learning curve (>60). Significant regional differences were observed in annual and career PD volumes ( P P Conclusions Globally, there is significant variability in the practice of PD. Many of these choices contrast with established randomized evidence and may contribute to variance in outcomes.
Figures & Tables
📖 Papers frequently viewed together
543 Citations
324 Citations
10 Authors (Claudio Bassi, ..., M.W. Büchler)
3,350 Citations
#1WeiTao Que (Zhengzhou University)H-Index: 1
#2Fang Hongbo (Zhengzhou University)H-Index: 6
Last. Shuijun Zhang (Zhengzhou University)H-Index: 16
view all 7 authors...
Abstract Background The best reconstruction method for the pancreatic remnant after pancreaticoduodenectomy remains debatable. We aimed to investigate the perioperative outcomes of 2 popular reconstruction methods: pancreaticogastrostomy and pancreaticojejunostomy. Data Sources Randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy were identified from literature databases (MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library). The meta-analysis included ...
47 CitationsSource
#1Benjamin Menahem (French Institute of Health and Medical Research)H-Index: 13
#2Lydia GuittetH-Index: 18
Last. Jean LubranoH-Index: 10
view all 5 authors...
Abstract To review prospective randomized controlled trials to determine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is associated with lower risks of mortality and pancreatic fistula after pancreaticoduodenectomy (PD). Previous studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures. MEDLINE, the Cochrane Trials Register, and EMBASE were searched for prospective rand...
95 CitationsSource
#1Fu-bao Liu (Anhui Medical University)H-Index: 7
#2Jiangming Chen (Anhui Medical University)H-Index: 5
Last. Xiao-Ping Geng (Anhui Medical University)H-Index: 2
view all 7 authors...
Objectives This study aimed to compare pancreaticojejunostomy (PJ) with pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD).
37 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2William E. Fisher (BCM: Baylor College of Medicine)H-Index: 58
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
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).
62 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2John D. Christein (UAB: University of Alabama at Birmingham)H-Index: 35
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 9 authors...
Background Most accrued evidence regarding prophylactic octreotide for a pancreatoduodenectomy (PD) predates the advent of the International Study Group of Pancreatic Fistula (ISGPF) classification system for a post-operative pancreatic fistula (POPF), and its efficacy in the setting of high POPF risk is unknown. The Fistula Risk Score (FRS) predicts the risk and impact of a clinically relevant (CR)-POPF and can be useful in assessing the impact of octreotide in scenarios of risk.
57 CitationsSource
#1Ayman El Nakeeb (Mansoura University)H-Index: 21
#2Emad Hamdy (Mansoura University)H-Index: 12
Last. T. Abdallah (Mansoura University)H-Index: 7
view all 9 authors...
Abstract Objectives The optimal strategy for the reconstruction of the pancreas following pancreaticoduodenectomy (PD) is still debated. The aim of this study was to compare the outcomes of isolated Roux loop pancreaticojejunostomy (IRPJ) with those of pancreaticogastrostomy (PG) after PD. Methods Consecutive patients submitted to PD were randomized to either method of reconstruction. The primary outcome measure was the rate of postoperative pancreatic fistula (POPF). Secondary outcomes included...
65 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 35
view all 2 authors...
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.
45 CitationsSource
#1Peter J. Allen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 97
#2Mithat GonenH-Index: 139
Last. William R. JarnaginH-Index: 123
view all 12 authors...
Background Postoperative pancreatic fistula is a major contributor to complications and death associated with pancreatic resection. Pasireotide, a somatostatin analogue that has a longer half-life than octreotide and a broader binding profile, decreases pancreatic exocrine secretions and may prevent postoperative pancreatic fistula. Methods We conducted a single-center, randomized, double-blind trial of perioperative subcutaneous pasireotide in patients undergoing either pancreaticoduodenectomy ...
261 CitationsSource
#1George Van Buren (BCM: Baylor College of Medicine)H-Index: 18
#2Mark Bloomston (OSU: Ohio State University)H-Index: 43
Last. William E. Fisher (BCM: Baylor College of Medicine)H-Index: 58
view all 30 authors...
Abstract To test by randomized prospective multicenter trial the hypothesis that pancreaticoduodenectomy (PD) without the use of intraperitoneal drainage does not increase the frequency or severity of complications. Some surgeons have abandoned the use of drains placed during pancreas resection. We randomized 137 patients to PD with (n = 68, drain group) and without (n = 69, no-drain group) the use of intraperitoneal drainage and compared the safety of this approach and spectrum of complications...
246 CitationsSource
#1Xu Min (SJTU: Shanghai Jiao Tong University)H-Index: 1
Objective To evaluate and compare the clinical effectiveness of pancreaticogastrostomy(PG)versus pancreaticojejunostomy(PJ) after pancreaticoduodenectomy(PD). Methods The Cochrane Library(2014,5th issue), Pub Med(from Jan. 1978 to May 2014), EMBASE(from Jan. 1966 to May 2014), SCI(from Jan. 1961 to May 2014), Chinese Bio-medicine database(from Jan. 1978 to May 2014), Chinese Journal Full-text Database(from Jan. 1994 to May 2014), VIP database(from Jan. 1989 to May 2014) and Wanfang database(from...
3 Citations
Cited By58
#1Lisa Suzanne Brubaker (BCM: Baylor College of Medicine)H-Index: 2
#2Fabio Casciani (University of Verona)H-Index: 2
Last. Chad G. Ball (U of C: University of Calgary)H-Index: 47
view all 0 authors...
Abstract null null Background null Intraperitoneal drain placement decreases morbidity and mortality in patients who develop a clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD). It is unknown whether multiple drains mitigate CR-POPF better than a single drain. We hypothesize that multiple drains decrease the complication burden more than a single drain in cases at greater risk for CR-POPF. null null null Methods null The Fistula Risk Score (FRS...
#1Roberto Salvia (University of Verona)H-Index: 52
#2Giovanni Marchegiani (University of Verona)H-Index: 29
Last. Claudio Bassi (University of Verona)H-Index: 110
view all 12 authors...
BACKGROUND The application of postoperative pancreatic fistula (POPF) risk stratification and mitigation strategies requires an update of the protocol for an early drain removal after pancreaticoduodenectomy (PD). The aim of the study is to highlight the unreliability of a single drain fluid amylase (DFA) cutoff-based protocol in the setting of a risk-based drain management. METHODS The role of postoperative day one (POD1) DFA in predicting POPF was explored in the setting of both selective drai...
2 CitationsSource
#1Fabio Casciani (UPenn: University of Pennsylvania)H-Index: 2
#2Claudio Bassi (University of Verona)H-Index: 110
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 3 authors...
Abstract Background Despite abundant, high-level scientific evidence, there is no consensus regarding the prevention, mitigation, and management of clinically relevant pancreatic fistula after pancreatoduodenectomy. The aim of the present investigation is three-fold: (1) to analyze the multiple decision-making points for pancreatico-enteric anastomotic creation and fistula mitigation and management after pancreatoduodenectomy, (2) to reveal the practice of contemporary experts, and (3) to indica...
3 CitationsSource
#1Roberto Salvia (University of Verona)H-Index: 52
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Claudio Bassi (University of Verona)H-Index: 110
view all 12 authors...
Abstract Background Academic hospitals must train future surgeons, but whether residents could negatively affect the outcomes of major procedures is a matter of concern. The aim of this study is to assess if pancreatic surgery is a safe teaching model. Methods Outcomes of 1230 major pancreatic resections performed at a high-volume pancreatic teaching hospital between 2015 and 2018 were compared according to the first surgeon type, attending vs resident. Results Residents performed a selection of...
1 CitationsSource
#1Peadar S Waters (Peter MacCallum Cancer Centre)H-Index: 5
#2Julie Flynn (Epworth Hospital)
Last. Alexander G. Heriot (Epworth Hospital)H-Index: 55
view all 10 authors...
BACKGROUND Although currently limited, the requirement for colorectal trainees to attain skills in robotic surgery is likely to increase due to further utilization of robotic platforms globally. The aim of the study is to describe the training programme utilized and assess outcomes of fellowship training in robotic colorectal surgery. METHODS A structured robotic training programme was generated across a tertiary hospital setting. Review of four prospectively maintained fellow operative logbooks...
Background The standard treatment for ampullary adenocarcinoma is pancreaticoduodenectomy. Identification of preoperative risk factors might help the clinician to select patients fit for resection and potentially decrease morbidity and mortality after PD. We conducted a cohort study to determine the preoperative factors related to 90-day severe morbidity and mortality after PD. Methods We conducted a retrospective cohort study in patients with a diagnosis of ampullary adenocarcinoma who underwen...
#1Kenichi Oshiro (Jichi Medical University)H-Index: 1
#2Kazuhiro Endo (Jichi Medical University)H-Index: 8
Last. Naohiro Sata (Jichi Medical University)H-Index: 27
view all 9 authors...
BACKGROUND Pancreatojejunostomy (PJ) is one of the most difficult and challenging abdominal surgical procedures. There are no appropriate training systems available outside the operating room (OR). We developed a structured program for teaching PJ outside the OR. We describe its development and results of a pilot study. METHODS We have created this structured program to help surgical residents and fellows acquire both didactic knowledge and technical skills to perform PJ. A manual was created to...
#1Nuerzatijiang Anweier (XMU: Xinjiang Medical University)
#2Shadike ApaerH-Index: 4
Last. Tuerhongjiang TuxunH-Index: 9
view all 8 authors...
OBJECTIVES To evaluate comparative outcomes of routine abdominal drainage (RAD) and non-routine abdominal drainage (NRAD) during elective hepatic resection for hepatic neoplasms. MATERIALS AND METHODS We systematically searched MEDLINE, EMBASE, The Cochrane Library, Web of Science. The searching phrases included "liver resection," "hepatic resection," "hepatectomy," "abdominal drainage," "surgical drainage," "prophylactic drainage," "intraperitoneal drainage," "drainage tube," "hepatectomy," "ab...
#1Kjetil Søreide (University of Bergen)H-Index: 63
#2Ville Sallinen (UH: University of Helsinki)H-Index: 20
Last. Rowan W. Parks (Edin.: University of Edinburgh)H-Index: 52
view all 4 authors...
One of the most dreaded complications of pancreatic surgery is the development of a post-operative pancreatic fistula (POPF). Appropriate understanding of the underlying pathophysiology, risk factors and perioperative mechanisms may allow for better management and use of preventive measures. Several risk scores have been developed but none are perfect in predicting POPF risk. Recognized factors include those related to the patient, the pathology and perioperative care. Interventions such as use ...
#1George Van Buren (BCM: Baylor College of Medicine)H-Index: 18
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
Pancreatic fistula has been the defining complication and challenge of pancreatic surgery. Better awareness and mitigation of postoperative pancreatic fistulas has led to significant improvements in morbidity and mortality of pancreatic surgery. The definition and management of pancreatic fistulas has sequentially progressed over the last three decades; the literature ranges from retrospective, observational studies to prospective multicenter randomized controlled trials. The landmark literature...
1 CitationsSource