Pancreatic Cancer, Periampullary Carcinoma
Conditions
Keywords
Pancreaticoduodenectomy, pancreatic fistula, pancreatic cancer, reoperation
Brief summary
The aim of this study is to outline the incidence of early and late reoperation after PD, examine the risk factors for early surgical intervention and its impact on the surgical outcome, hospital stay, diseases recurrence and patient survival, address variable indications for late readmission and reoperation after PD and its impact on patient survival and disease recurrence.
Detailed description
This is a retrospective cohort study of all patients who underwent PD for periampullary tumors in Gastrointestinal Surgical Center (GISC), Mansoura University, Egypt in the period between 2000 and 2018.The exclusion criteria included any patients with locally advanced periampullary tumor, metastases, patients with advanced liver cirrhosis (Child B or C), malnutrition, or coagulopathy. Patient data were recorded in a prospectively maintained database. Preoperative variables included; age, sex, body mass index, patients' symptoms and signs, laboratory tests, tumor markers and preoperative biliary drainage. Intraoperative variables included; liver status, tumor size, pancreatic duct diameter, texture of the pancreas, operative time, blood loss, pancreatic reconstruction method and blood transfusion. Postoperative variables included postoperative complications, drain amylase, liver function, day to resume oral feeding, postoperative stay, re-exploration, hospital mortality, postoperative pathology, and surgical safety margins. Data regarding reoperation included incidence, male to female ratio, hospital stay, interval to reoperation, number of explorations, indication of reoperation and surgical management, and postoperative outcome in terms of morbidity and hospital stay. Follow-up was carried out one week postoperatively, 3 months, 6 months and then after one year. The minimum duration of follow up was 2 years. Follow up was done by thorough history taking, clinical examination and abdominal CT in case of suspicious lesions on pelvi-abdominal ultrasound.
Interventions
PROCEDURESurgical re-interventionafter pancreaticoduodenectomy
Mandatory surgical management of complications after pancreatico-duodenectomy through peritoneal lavage, draiange, repair of fistula, completion pancreatectomy, control of bleeding, bowel resection, and feeding jejunostomy.
Sponsors
Mansoura University
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
15 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* all patients who underwent pancreaticoduodenectomy for periampullary malignant lesions in the duration between January 2000 and May 2018
Exclusion criteria
* Pancreaticoduodenectomy performed for benign tumors, recurrent malignant tumors, chronic pancreatitis, or inflammatory strictures were excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient survival | 2-20 years after surgery | The duration between surgical intervention to patient death |
| Tumor recurrence | 2-20 years | Duration between surgery and recurrence of periampullary tumors based on radiological or endoscopic investigations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital stay after reoperation | 10-90 days after reoperation | duration between reoperation surgery to discharge from hospital |
| Morbidity after reoperation | 10-90 days after reoperation | complications after reoperation including intr- or extra-luminal hemorrhage, pancreatic or gastric fistula, biliary leakage, thromboembolic diseases, and wound infection |
| Risk factors for surgical reoperation | Before surgical intervention | Factors that increase the probability that the patient undergoing pancreaticoduodenectomy would be at higher risk for reoperation |
Outcome results
None listed