Anatomy-Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection

Background  

The anatomical status of the pancreatic remnant after a pancreatic head resection varies greatly among patients. The aim of the present study was to improve management of the pancreatic remnant for reducing pancreatic fistula after pancreatic head resection.     

Intraoperative Assessment of Pancreatic Neck Margin at the Time of Pancreaticoduodenectomy Increases Likelihood of Margin-Negative Resection in Patients with Pancreatic Cancer

Background  

The utility of intraoperative assessment of surgical margins is often debated by experienced pancreatic surgeons. We sought to review our experience with pancreaticoduodenectomy (PD) for pancreatic cancer to determine the impact of intraoperative frozen section (FS) analysis on margin-negative resection and long-term outcome.     

Effect of TachoSil Patch in Prevention of Postoperative Pancreatic Fistula

Background  

Postoperative pancreatic fistula (POPF) is a severe complication after pancreatic resections. The aim was to assess if application of TachoSil? patch could reduce incidence of postoperative fistulas after laparoscopic distal pancreatic resections.     

Enucleation of Pancreatic Cystadenomas

Background  

Optimal surgical treatment of pancreatic cystadenomas is controversial due to the rarity of the tumors and paucity of studies regarding long-term outcomes. This is especially true for large pancreatic cystadenomas. The objective of this study was to determine the safety and effectiveness of treating pancreatic cystadenomas by enucleation.     

A Focal Mass-Forming Autoimmune Pancreatitis Mimicking Pancreatic Cancer with Obstruction of the Main Pancreatic Duct

Introduction and background  

Autoimmune pancreatitis (AIP) is a rare disease that closely mimics pancreatic cancer (PC) in its presentation. It is very important for clinicians to distinguish one from the other because their treatment and prognosis are vastly different. Typical radiological imaging findings, in particular observation of diffusely or segmentally narrowed main pancreatic duct (MPD) with an irregular wall by endoscopic retrograde cholangiopancreatography (ERCP), are essential for making the diagnosis of AIP. On the other hand, MPD obstruction is one of the most frequent features on ERCP.     

CC Chemokine Receptor 9 Enhances Proliferation in Pancreatic Intraepithelial Neoplasia and Pancreatic Cancer Cells

Introduction  

Chemokine receptors may regulate the progression and metastasis of invasive malignancies. There are little data, however, regarding their role in premalignant lesions. Our objective was to determine the role of CC chemokine receptor 9 (CCR9) in pancreatic intraepithelial neoplasia (PanIN).     

Intra-abdominal Fat Predicts Survival in Pancreatic Cancer

Background  

Body mass index (BMI) has proven unreliable in predicting survival following pancreaticoduodenectomy for cancer. While measures of intra-abdominal fat correlate with medical and postoperative complications of obesity, the impact of intra-abdominal fat on pancreatic cancer survival is uncertain. We hypothesized that the quantity of intra-abdominal fat would predict survival following resection of pancreatic cancer.     

Laparoscopic Drainage of Pancreatic Pseudocysts: a Methodological Approach

Background  

This paper describes our tailored and methodological approach to laparoscopic drainage of pancreatic pseudocysts (PPs) based on an anatomical classification.     

Preoperative Diabetes Mellitus and Long-Term Survival After Resection of Pancreatic Adenocarcinoma

Purpose  

To assess clinicopathologic features and postresection survival of diabetes mellitus (DM)-associated pancreatic ductal adenocarcinoma (PDAC).     

Potential Contribution of Preoperative Neoadjuvant Concurrent Chemoradiation Therapy on Margin-Negative Resection in Borderline Resectable Pancreatic Cancer

Background  

Margin-negative pancreatectomy provides only chance to cure pancreatic cancer. However, borderline resectable pancreatic cancer (BRPCa) has the risk of incomplete palliative resection.     

Surveillance of Pancreatic Cancer Patients after Surgical Resection

Background  

There are no clear recommendations to guide posttreatment surveillance in patients with pancreatic cancer. Our goal was to describe the posttreatment surveillance patterns in patients undergoing curative-intent resection for pancreatic cancer.     

Discrepancy Between the Extent of Pancreatic Necrosis and Multiple Organ Failure Score in Severe Acute Pancreatitis

Background  

Whether pancreatic necrosis is a prerequisite for the development of multiorgan failure (MOF) in severe acute pancreatitis (AP) is not clear and has implications for the rational design of translational therapies. This study was designed to investigate the magnitude of any association between MOF and radiologically evident pancreatic or extrapancreatic complications of AP.     

Laparoscopic Pylorus-Preserving Pancreatic Head Resection and Hybrid Open Reconstruction via Pancreatogastrostomy

Introduction  

Laparoscopic pancreatic surgery is ambitious and should only be performed in institutions with expert knowledge in pancreatic surgery.     

Association Between the Incidence of Pancreatic Fistula After Pancreaticoduodenectomy and the Degree of Pancreatic Fibrosis

Objective

The objective of this study is to investigate the association between the incidence of pancreatic fistula after pancreaticoduodenectomy (PD) and the degree of pancreatic fibrosis.

Method

Between January 2013 and December 2016, the analysis of the clinical data of 529 cases of pancreaticoduodenectomy patients of our hospital was performed in a retrospective fashion. The univariate analysis and multivariate analysis were done using the Pearson chi-squared test and binary logistic regression analysis model; correlations were analyzed by Spearman rank correlation analysis. The value of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy was evaluated by the area under the receiver operating characteristic (ROC) curve.

Results

The total incidence of pancreatic fistula after pancreaticoduodenectomy was 28.5% (151/529). Univariate analysis and multivariate analysis showed that BMI?≥?25 kg/m², pancreatic duct size ≤?3 mm, pancreatic CT value<?30, the soft texture of the pancreas (judged during the operation), and the percent of fibrosis of pancreatic lobule ≤?25% are prognostic factors of pancreatic fistula after pancreaticoduodenectomy (P?<?0.05); the pancreatic CT value and the percent of fibrosis of pancreatic lobule in pancreatic fistula group were both lower than those in non-pancreatic fistula group (P?<?0.05). Results indicated that there is a negative correlation between the severity of pancreatic fistula and the pancreatic CT value or the percent of fibrosis of pancreatic lobule (r?=???0.297, ??0.342, respectively). The areas under the ROC curve of the percent of fibrosis of pancreatic lobule and the pancreatic CT value were 0.756 and 0.728, respectively.

Conclusion

The degree of pancreatic fibrosis is a prognostic factor which can influence the pancreatic texture and the incidence of pancreatic fistula after pancreaticoduodenectomy. The pancreatic CT value can be used as a quantitative index of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy.

     

Postoperative Pancreatic Fistula and the Risk Factors of Laparoscopy-Assisted Distal Gastrectomy for Early Gastric Cancer

Background  

Laparoscopy-assisted distal gastrectomy (LADG) was introduced as minimally invasive surgery for early gastric cancer (EGC) in Japan. This study investigated postoperative pancreatic fistula (POPF) and associated risk factors of the procedure.     

Dual-Phase Computed Tomography for Assessment of Pancreatic Fibrosis and Anastomotic Failure Risk Following Pancreatoduodenectomy

Introduction  

Delayed or decreased computed tomography (CT) enhancement characteristics in pancreatic fibrosis have been described.     

Contemporary Management of Nonfunctioning Pancreatic Neuroendocrine Tumors

Background  

This article reviews the current literature and recommendations pertaining to the management of nonfunctioning pancreatic neuroendocrine tumors.     

A Preoperative Predictive Scoring System for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy

Background  

Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity after pancreaticoduodenectomy (PD). In the present study we sought to establish a preoperative scoring system with which to predict this complication.     

Pancreas-Protocol Imaging at a High-Volume Center Leads to Improved Preoperative Staging of Pancreatic Ductal Adenocarcinoma

Background  

High-quality preoperative cross-sectional imaging is vital to accurately stage patients with pancreatic ductal adenocarcinoma (PDAC). We hypothesized that imaging performed at a high-volume pancreatic cancer center with pancreatic imaging protocols more accurately stages patients compared with pre-referral imaging.     

Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands

Background  

Centralization of pancreatic surgery in high-volume hospitals is under debate in many countries. In the western part of the Netherlands, the professional network of surgical oncologists agreed to centralize all pancreatic surgery from 2006 in two high-volume hospitals. Our aim is to evaluate whether centralization of pancreatic surgery has improved clinical outcomes and has changed referral patterns.