Pancreas Cancer, Pancreatectomy
Conditions
Keywords
Pancreatectomy, Gastric venous outflow reconstruction, Gastric venous congestion
Brief summary
Total pancreatoduodenectomy (TP) is the standard surgical approach for treatment of extended pancreas tumors. If the gastric coronary vein has to be sacrificed for oncologic or for technical reasons in total pancreatectomy with splenectomy, gastric venous congestion (GVC) may result because all major venous draining routes are terminated. In the sequelae of GVC, gastric venous infarction ultimately leads to gastric perforation with abdominal sepsis. To avoid gastric venous infarction, partial or even total gastrectomy is usually performed in the event of GVC after TP. However, this significantly impacts the patient's quality of life. Reconstruction of gastric venous outflow represents a technical approach to overcome GVC and to avoid gastric venous infarction making (partial) gastrectomy unnecessary. The current study aims to assess the role of gastric venous outflow reconstruction in GVC after TP to prevent (partial) gastrectomy.
Interventions
PROCEDUREGastric venous reconstruction
Patients will be assigned to study after intraoperative evaluation of gastric venous drainage after coronary vein resection during TP, and the gastric venous outflow will be reconstructed after TP.
Sponsors
University Hospital Heidelberg
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Patients will be assigned to study after intraoperative evaluation of gastric venous drainage after coronary vein resection during TP. During surgery, onsite evaluation by the surgeon, endoscopic examination, indocyanine green, gastric venous drainage flowmetry, and spectral analysis will be performed. After surgery, patients will receive standard post-TP care and treatment. During hospitalization, endoscopic examination with indocyanine green will be performed on the first, third, and seventh postoperative day to evaluate gastric ischemia. Ischemia markers will be evaluated daily after surgery. After discharge, patients will be followed up for 30 days, during which mortality and morbidities will be recorded.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Provide written informed consent * Elective total pancreatectomy for malignant or benign pancreatic lesions or chronic pancreatitis with splenectomy * Intraoperative ligation of coronary vein
Exclusion criteria
* Gastric resection due to malignant infiltration * Non-reconstructable gastric venous drainage * Previous pancreas surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of gastric venous congestion | 30 days postoperative | Gastric venous congestion after gastric venous reconstruction following total pancreatectomy |
| Incidence of gastric ischemia | 30 days postoperative | Gastric ischemia after gastric venous reconstruction following total pancreatectomy |
| Postpancreatectomy gastrectomy rate | 30 days postoperative | Rate of gastrectomy after gastric venous reconstruction following total pancreatectomy |
| Reoperation rate | 30 days postoperative | Reoperation rate after gastric venous reconstruction following total pancreatectomy |
| Morbidity rate | 30 days postoperative | Complications rate after gastric venous reconstruction following total pancreatectomy |
| Mortality rate | 30 days postoperative | Mortality rate after gastric venous reconstruction following total pancreatectomy |
Countries
Germany
Contacts
Primary ContactArianeb Mehrabi, MD
Outcome results
None listed