medigraphic.com
Asociación Mexicana de Gastroenterología

2006, Number 3

Next >>

Rev Gastroenterol Mex 2006; 71 (3)

Pancreatoduodenectomy: results in a large volume center

Chan C, Franssen B, Uscanga L, Robles G, Campuzano M

Language: Spanish
References: 28
Page: 252-256
PDF size: 90.58 Kb.


ABSTRACT

Objective: Analyze the experience with pancreaticoduodenectomy (PD) at the INCMNSZ. Background data: PD has become a popular procedure in hospitals throughout the USA and Europe in the last 25 years, where mortality is ‹ 5% y morbidity remains around 40%. Nonetheless there are very few reports on PD in Latin America. Methods: The data of all PD´s performed at the INCMNSZ between 1999 and 2005 was gathered prospectively and analyzed retrospectively. Results: 133 PDs where performed; 47.5% where men and 52.5% where women. Median of age was 57.7 years. 81.5% underwent classical resection and 18.5% a pylorus preserving procedure. Intraoperative variables include : blood loss: 940 mL. (± 1,000). transfusion requirements: 1.9 U, median operative time: 5:49 (± 1:02) and median hospital stay: 14 days. Most frequent diagnosis include ampulary adenocarcinoma and pancreatic cancer. Mortality in the entire series was 9.2%, decreased to 2.7% in the 2002-2005 period and from April 2003 has remained in 0. A total of 14 portal-superior mesenteric vein resections where performed. Conclusions: To our knowledge this is the largest series of PD in Latin America. Popularity and indications for PD are expanding. Mortality is acceptable and morbidity remains high despite much effort. This procedure is performed with a satisfactory outcome in high volume centers. Involvement of the portal-superior mesenteric vein is not a contraindication of PD.


REFERENCES

  1. Halsted WS. Contributions to the surgery of the bile passages, especially of the common bile duct. Boston Med Surg J 1899; 141: 645-54.

  2. Kausch W. Das carcinom der papilla duodeni und seine radikale Entfeinung. Beitr Z Clin Chir 1912; 78: 439-86.

  3. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935; 102: 763-79.

  4. Trimble IR, Parsons JW, Sherman CP. A one-stage operation for the cure of carcinoma of the ampulla of Vater and of the head of the pancreas. Surg Gynecol Obstet 1941; 73: 711-22.

  5. Hirschel G. Die resektion des duodenums mit der papille wegen karzinoms. Muchen Med Wchnschr 1914; 61: 1728-9.

  6. Warshaw AL, Fernandez del Castillo C, Pancreatic carcinoma. N Engl J Med 1992; 326: 455-65.

  7. Yeo CJ, Cameron JL, Lillemoe, et al. Pancreticoduodenectomy for cancer of the head of the páncreas. Ann Surg 1995; 221: 721-31.

  8. Neoptolemos JP, Russel RC, Bramhall S, et al. Low mortality after pancreaticoduodenectomy for pancreatic and periampullary tumours in 1026 patients. Br J Surg 1997; 84: 1370-6.

  9. Trede M, Schwall G, Saeger H-D. Survival after pancreaticoduodenectomy: 118 consecutive resections with an operative mortality. Ann Surg 1990; 211: 447-58.

  10. Vickers SM, Chan C, Heslin MJ, Bartolucci A, Aldrete JS. The role of pancreaticoduodenectomy in the treatment of severe chronic pancreatitis. Am Surg 1999; 65: 1108-11.

  11. Balcom JH, Rattner DW, Warshaw AL, et al. Ten-year experience with 733 pancreatic resections. Arch Surg 2001; 13: 391-8.

  12. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997; 226(3): 248-57.

  13. Ruggieri JP. Pancreaticogastrostomy. Rev Fac Cien Med Univ Nac Cordoba 1999; 56(1): 103-6.

  14. Morales-Linares JC, Gomez-Mendez TJ, Chan C, Quintanilla-Martinez L, Uscanga L, Robles-Diaz G, de la Garza L, Campuzano M, Herrera MF Pancreatoduodenectomy in the treatment of carcinoma of Vater’s ampulla. Rev Invest Clin 1996; 48(3): 185-9.

  15. Gomez-Mendez TJ, Morales-Linares JC, Chan C, Quintanilla L, de la Garza L, Herrera MF. 7 cases of carcinoma of the distal choledochus. Rev Invest Clin 1995; 47(4): 291-5.

  16. De la Garza L. The surgical possibilities in patients with adenocarcinoma of the pancreas. Rev Gastroenterol Mex 1995; 60(2): 84-93.

  17. Barboza BE. Pancreatoduodenectomy: myth or reality? Personal experience. Rev Gastroenterol Peru 1993; 13(3): 160-7.

  18. Crile GJr. The advantages of bypass operations over radical pancreaticoduodectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet 1970; 130: 1049-53.

  19. Shapiro TM. Adenocarcinoma of the pancreas. Ann Surg 1975; 182: 715-21.

  20. Sohn TA, Yeo CJ, Cameron JL, Hruban RH, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004; 239(6): 788-97.

  21. Phelan HA, Minei JP. Pancreatic trauma: diagnostic and therapeutic strategies. Curr Treat Options Gastroenterol 2005; 8(5): 355-63.

  22. Scheiman JM. Cystic lesions of the pancreas. Gastroenterol 2005; 128: 463-9.

  23. Torres-Villalobos G, Podgaetz E, Anthon FJ, Remes-Troche JM, Robles-Díaz G, Chan C. Single pancreatic metastasis from a previously resected carcinoma of the cecum: a case report. Current Surg 2004: 61(4): 380-5.

  24. Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995; 222: 638-45.

  25. Birkmeyer JD, Finlayson SR, Tosteson A, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 1999; 125: 250-6.

  26. Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 1989; 1124: 127-32.

  27. Orozco H, Mercado MA. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Arch Surg 2003; 138(9): 940.

  28. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastointest Surg 2004; 8: 935-50.




2020     |     www.medigraphic.com