Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · May 2012
Comparative StudyNumber of lymph nodes evaluated: prognostic value in pancreatic adenocarcinoma.
The impact of the number of lymph node (LN) evaluated pathologically on accurate staging is unknown. Our primary aim was to determine a minimum number of evaluated LN needed to provide accurate staging of pancreatic cancer. ⋯ Patients with "N0" disease with <11 LN evaluated pathologically have worse survival, suggesting that metastatic nodes were missed by evaluating too few nodes. For pN1 patients, LNR stratifies survival of patient cohorts more accurately. Adequate staging of pancreatic cancer requires pathologic evaluation of ≥11 LNs.
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J. Gastrointest. Surg. · May 2012
Comparative StudyLimitations of patient-associated co-morbidity model in predicting postoperative morbidity and mortality in pancreatic operations.
Patient-associated co-morbidities are a potential cause of postoperative complications. The National Surgical Quality Improvement Project (NSQIP) collects data on patient outcomes to provide risk-adjusted outcomes data to participating hospitals. However, operations which may have a high distribution of technically-related complications, such as pancreatic operations, may not be adequately assessed using such predictive models. ⋯ These data imply that the factors used to assess postoperative mortality and morbidity may not completely explain postoperative outcomes in pancreatic operations. These procedures are technically demanding and can have morbidities not related to pre-existing co-morbid conditions; therefore, preoperative prediction based on pre-existing co-morbidities may have limitations in these types of operations.
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J. Gastrointest. Surg. · May 2012
Comparative StudyEnteral nutrition reduces delayed gastric emptying after standard pancreaticoduodenectomy with child reconstruction.
Delayed gastric emptying (DGE) is a common complication following pancreaticoduodenectomy (PD). Our retrospective study aimed to evaluate the influence of enteral nutrition (EN) on DGE incidence after standard PD with antrectomy and Child reconstruction. ⋯ EN reduces DGE and postpancreatectomy hemorrhage after PD.
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J. Gastrointest. Surg. · May 2012
Comparative StudyReappraisal of hepatopancreatoduodenectomy as a treatment modality for bile duct and gallbladder cancer.
Hepatopancreatoduodenectomy has been performed to achieve radical resection in malignant biliary tumors. We reviewed clinical outcomes to evaluate the clinical feasibility of hepatopancreatoduodenectomy for the treatment of gallbladder and bile duct cancer. ⋯ To obtain negative proximal and distal ductal resection margins in the biliary tract cancer, R0 resection and long-term survival can be achieved by hepatopancreatoduodenectomy. However, its adoption in patients with lymph node metastasis or adjacent organ invasion cannot be recommended.
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J. Gastrointest. Surg. · May 2012
Comparative StudyAfter distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure.
The method to lower postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) involves controlling risk factors for leakage from the pancreatic stump. ⋯ Using the ISGPS definition and its web-based tool, the incidence of clinically relevant leakage was 14.8% in 223 cases of DP. Opportunities to lower this rate are improving our surgical drain technology, limiting intraoperative blood loss, and avoiding postoperative intravenous narcotics with epidural analgesia.