alexa Structured intraoperative assessment of pancreatic gland characteristics in predicting complications after pancreaticoduodenectomy.


Journal of Integrative Oncology

Author(s): Ansorge C, Strmmer L, AndrnSandberg , Lundell L, Herrington MK,

Abstract Share this page

Abstract BACKGROUND: The morbidity rate after pancreaticoduodenectomy remains high (20-50 per cent) and postoperative pancreatic fistula (POPF) is a major underlying factor. POPF has been reported to be associated with pancreatic consistency (PC) and pancreatic duct diameter (PDD). The aim was to quantify the risk of pancreaticojejunostomy-associated morbidity (PJAM) by means of a structured intraoperative assessment of both characteristics. METHODS: This single-centre prospective observational study included pancreaticoduodenectomies performed between 2008 and 2010 with a standardized duct-to-mucosa end-to-side pancreaticojejunostomy. PC and PDD were assessed during surgery and classified into four grades each (from very hard to very soft, and from larger than 4 mm to smaller than 2 mm, respectively). PJAM was defined as POPF (grade B or C in International Study Group on Pancreatic Fistula classification) or symptomatic peripancreatic collection of either abscess or fluid. PJAM of at least Clavien grade IIIb was considered severe. RESULTS: PJAM and POPF were observed in 24 (21·8 per cent) and 17 (15·5 per cent) of 110 patients respectively. Softer PC and smaller PDD were risk factors for POPF (both P < 0·001), symptomatic peripancreatic collections (P = 0·071 and P = 0·015) and PJAM (both P < 0·001). Combining consistency and duct characteristics in a composite classification the PJAM risk was stratified as 'high' (both risk factors, PJAM incidence 51 per cent), 'intermediate' (softer PC or smaller PDD, PJAM 26 per cent) or 'low' (no risk factors, PJAM 2 per cent). Severe PJAM was observed only in patients with smaller PDD. CONCLUSION: A high-risk pancreatic gland had a 25-fold higher risk of PJAM after pancreaticoduodenectomy than a low-risk gland. This simple classification can contribute to more individualized patient management and allow stratification of study cohorts with homogeneous POPF risk. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article was published in Br J Surg and referenced in Journal of Integrative Oncology

Relevant Expert PPTs

Relevant Speaker PPTs

  • Seema Narayan
    A comparative study of the link between real exchange rate of ASEAN countries and fossil fuel prices
    PDF Version
  • Navinchandra G. Ashar
    Comparative study of techno-economic evaluation of the production of liquid Sulphur Di Oxide
    PDF Version
  • Wei Gong
    Wei Gong-Huazhong-University-of-Science-and-Technology-China-Probabilistic-seismic-hazard-assessment-for-the-pseudo-negative-stiffness-control-of- a-steel-base-isolated-building-A-comparative-study-
    PPT Version | PDF Version
  • Abdullah Altin
    PPT Version | PDF Version
  • Nahla A El-Wakil
    Comparative study of enzymatic and chemical denaturation of wheat gluten and their cellulosic nanocomposites
    PPT Version | PDF Version
  • Krzysztof Wieczerzak
    A comparative transcriptome provides candidate genes for determination the cause of males infertility.
    PPT Version | PDF Version
  • Flavia Secco Tavares de Souza
    A Comparative Study Among Elective Conventional Surgery, Urgency/Emergency Conventional Approaching and Elective Videolaparoscopic Surgery on the Treatment of Hospitalized Patients at First Surgeric Clinic of Federal Hospital of Bonsucesso with a Diagnostic of Colorectal adenocarcinoma, between January 2010 and December 2012
    PPT Version | PDF Version
  • Rajendra K Ray
    Comparative Study And Improvement Of Shallow-Water Models
    PPT Version | PDF Version
  • Nisreen E. Mahmoud
    Parasitological and comparative pathological studies on monogenean infestation of cultured sea bream (Sparus aurata, Sparidae) in Egypt.
    PPT Version | PDF Version

Recommended Conferences

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version