review of literature on clinical pancreatology - The Pancreapedia

LCS2000 cryogenic surgical system. All the animals' digestive tract was reconstructed withcholecystojejunostomy and gastroenterostomy, respectively. Acute necrotizing pancreatitisoccurred on all animals in group A, <strong>of</strong> which 5 <strong>of</strong> the 6 died within 1 week, whereas only 1 <strong>of</strong>the 6 reported a 4-week survival. All animals in group B survived during the observation, inwhich only a transient increment and a gradual correction <strong>of</strong> pancreatic amylase level wererecorded. Small pancreatic pseudocyst occurred in 1 case. It was concluded that mildhypothermic cryosurgery with liquid nitrogen superficial refrigeration might lead to pancreaticinjury and induce acute pancreatitis, yet deep hypothermic cryosurgery with adequate timeshowed a promising effect in destroying pancreatic tissue and preventing acute pancreatitis[485].Postoperative complicationsIt was aimed to compare different techniques using the definitions <strong>of</strong> the International StudyGroup <strong>of</strong> Pancreatic Surgery for postoperative complications after pancreaticoduodenectomy.The perioperative data <strong>of</strong> 119 patients that underwent pancreaticoduodenectomy bya single surgeon were retrospectively analyzed. Pancreaticojejunal anastomosis wasperformed using the dunking method (n=39), the duct-to-mucosa anastomosis method(n=40), and the duct-to-mucosa adaptation (n=40). The most frequent complication waspostoperative pancreatic fistula (POPF; grades A, 21 %; B, 8 %; and C, 3 %),postpancreatectomy hemorrhage (PPH; grades B, 7 % and C, 1 %), and delayed gastricemptying (DGE; grades A, 1 % and B, 6 %). No significant differences in POPF were foundbetween patients who underwent different types <strong>of</strong> pancreatic anastomoses. Only pancreaticductal adenocarcinoma and pancreatic texture were potentially related to POPF. Patientswith or without POPF grade A had significantly shorter postoperative stays than patients withgrade B or C POPF, and similar findings were obtained for DGE and PPH. It was concludedthat the successful management <strong>of</strong> pancreatic anastomoses depends more on a meticuloussurgical technique and appropriate experience rather than on the type <strong>of</strong> technique.Furthermore, the International Study Group <strong>of</strong> Pancreatic Surgery definitions <strong>of</strong> POPF, DGE,and PPH seem objective and universally acceptable [486].Surgical resultsAlthough a positive resection margin has been reported to be a strong prognostic factor afterresection for pancreatic cancer, several studies indicated that resection status did notindependently affect survival. The aim <strong>of</strong> one study was to examine the influence <strong>of</strong> resectionmargin status on survival after extended radical resection for pancreatic head cancer. Onehundred thirty-eight cases <strong>of</strong> pancreatoduodenectomy and 38 cases <strong>of</strong> pylorus-preservingpancreatoduodenectomy for invasive ductal carcinoma <strong>of</strong> the pancreas were retrospectivelyanalyzed. The resection margins were negative (R0) in 115 patients (65 %), microscopicallypositive (R1) in 38 patients (22 %), and grossly positive (R2) in 23 patients (13 %). Patientswith R1 resection survived significantly shorter (median survival time, MST, 9 months) thanR0 resection patients (MST, 15 months) but survived longer than R2 resection patients(MST, 6 months). By multivariate analysis, R2 resection, together with lymph nodemetastasis, portal venous system, and extrapancreatic nerve plexus invasions,independently affected the overall survival, but R1 resection was not significantly influential.It was concluded that R1 resection did not independently affect the survival [487].The authors analysed the results <strong>of</strong> 363 patients, who underwent surgery for pancreatic orperiampullary tumours. There were 175 operable and 188 inoperable cases. Thepreoperative data (age, gender, site <strong>of</strong> the tumour, characteristic clinical signs), as well assurgical methods are overviewed. A pancreatoduodenectomy was most frequently applied as