Gastric Venous Congestion After Total Pancreatectomy Is Frequent and Dangerous.

Published on Mar 4, 2021in Annals of Surgery12.969
· DOI :10.1097/SLA.0000000000004847
Martin Loos3
Estimated H-index: 3
(University Hospital Heidelberg),
Arianeb Mehrabi40
Estimated H-index: 40
+ 15 AuthorsMarkus W. Büchler177
Estimated H-index: 177
OBJECTIVE The aim of this study was to determine the role of gastric venous congestion (GVC) in mortality after total pancreatectomy (TP). BACKGROUND Data from a nationwide administrative database revealed that TP is associated with a 23% mortality rate in Germany. METHODS A total of 585 consecutive patients who had undergone TP (n = 514) or elective completion pancreatectomy (n = 71) between January 2015 and December 2019 were analyzed. Univariable and multivariable analyses were performed to identify risk factors for GVC and 90-day mortality. RESULTS GVC was observed in 163 patients (27.9%) requiring partial or total gastrectomy. Splenectomy (OR 2.14, 95% CI 1.25-3.80, p = 0.007) and coronary vein resection (OR 5.49, 95% CI 3.19-9.64, p < 0.001) were independently associated with GVC. The overall 90-day mortality after TP was 4.1% (24 of 585 patients), 7.4% in patients with GVC and 2.8% in those without GVC (p = 0.014). Of the 24 patients who died after TP, 12 (50%) had GVC. CONCLUSION GVC is a frequent albeit not well-known finding after TP, especially when splenectomy and resection of the coronary vein are performed. Adequate decision making for partial gastrectomy during TP is crucial. Insufficient gastric venous drainage after TP is life-threatening.
Cited By3
#1Mohammed Al-Saeedi (University Hospital Heidelberg)H-Index: 10
#2Leonie Frank-Moldzio (University Hospital Heidelberg)
Last. Arianeb Mehrabi (University Hospital Heidelberg)H-Index: 40
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Resection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications. This study describes the surgical technique, postoperative course, and surgical outcomes of SRS afte...
#1Roberto Salvia (University of Verona)H-Index: 57
#2Gabriella Lionetto (University of Verona)H-Index: 1
Last. Giovanni Marchegiani (University of Verona)H-Index: 32
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Postoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a prom...
#1Thomas Hank (University of Vienna)H-Index: 11
#2Ulla Klaiber (University of Vienna)H-Index: 18
Periampullare Neoplasien sind eine heterogene Gruppe verschiedener Tumorentitaten der periampullaren Region, von denen das Pankreasadenokarzinom mit 60–70 % am haufigsten ist. Wie typisch fur Pankreaskarzinome zeichnen sich periampullare Pankreaskarzinome durch ein aggressives Wachstum und eine fruhe systemische Progression aus. Aufgrund ihrer besonderen Lage in unmittelbarer Nahe zur Papilla Vateri treten Symptome in eher fruherem Tumorstadium auf, sodass die Therapiemoglichkeiten und Prognose ...
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