review of literature on clinical pancreatology - The Pancreapedia

managed by endovascular treatment or arterial reconstruction. In conclusion the authorspropose a management algorithm to prevent the consequences <strong>of</strong> celiac axis stenosis [461].Preoperative biliary drainageIt was examined the effect <strong>of</strong> selective preoperative biliary drainage (BD) on perioperativeresuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy.Biliary drainage prior to pancreaticoduodenectomy remains controversial. Proponents arguethat it facilitates referral to high-volume tertiary centers, while detractors maintain that itincreases surgical morbidity and mortality. It was performed a retrospective analysis <strong>of</strong>single-institution tumor registry database. From 2003 to 2008 90 patients underwentpancreaticoduodenectomy for periampullary mass lesions. Clinicopathologic data were<strong>review</strong>ed and analyzed among patients who did and did not receive biliary drainage for theirassociation with perioperative outcomes. Fifty-six patients (62 %) underwent BD, and 34 (38%) did not. Intraoperative bile cultures were positive for 1 or more species <strong>of</strong> microorganismsin 88 percent <strong>of</strong> stented patients (35 <strong>of</strong> 40). There were no significant differences in fluidrequirements, transfusion requirements, or surgery duration between patients who did anddid not undergo biliary drainage. Estimated blood loss was significantly increased in patientswho received biliary drainage (625 mL vs 525 mL in patients who did not undergo BD), whilereoperation was significantly more common in nonstented patients (4 % vs 15 % in patientswho did not undergo BD). Intensive care unit stay, overall length <strong>of</strong> stay, pancreaticleak/abscess/fistula, infectious complications, postoperative percutaneous drainage, hospitalreadmission, and 30- and 90-day mortality were not significantly different between the twogroups. Although preoperative biliary stents may complicate the intraoperative managementand lessen the postoperative complications <strong>of</strong> patients undergoing pancreatic resection, onlyestimated blood loss and reoperation were significantly different in this cohort. Currently,selective preoperative BD appears appropriate in the multidisciplinary management <strong>of</strong>patients with periampullary lesions [462].In one study it was evaluated whether preoperative biliary drainage should be routinelyperformed in patients with jaundice. The 342 patients undergoing pancreaticoduodenectomybetween 2004 and 2008 were analyzed. Of these patients, 303 without biliary drainage weredivided into 4 groups: (1) no jaundice, (2) mild jaundice, (3) moderate jaundice, and (4)severe jaundice. Postoperative complications were stratified by severity according to themodified Clavien classification. It was found that patients with jaundice had a higherincidence in subsequent complications than those with no jaundice. The complications werestratified by severity. Compared with those in group 1, patients in groups 2, 3, and 4 hadsignificantly more complications just in grade 2 (16 %, 23 %, 28 %, and 40 %, respectively),but not other more severe grades including 3a, 3b, 4a, 4b, and 5; all <strong>of</strong> the complications inthis grade could be conservatively treated and cured without requiring surgical, endoscopic,or radiological intervention. The incidences <strong>of</strong> infection and overall complications were higherin patients with drainage than those without, but neither difference was statisticallysignificant. Preoperative drainage should not routinely be performed in patients with jaundicescheduled for pancreaticoduodenectomy, and immediate surgery is preferable [463].ExperimentalOne work presented a novel approach to producing manganese (Mn)-doped quantum dots(Mnd-QDs) emitting in the near-infrared (NIR). Surface functionalization <strong>of</strong> Mnd-QDs withlysine makes them stably disperse in aqueous media and able to conjugate with targetingmolecules. The nanoparticles were structurally and compositionally characterized andmaintained a high photoluminescence quantum yield and displayed paramagnetism in water.The receptor-mediated delivery <strong>of</strong> bioconjugated Mnd-QDs into pancreatic cancer cells was