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Chang Moo Kang - One of the best experts on this subject based on the ideXlab platform.
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Repeated Pancreatectomy for Isolated Local Recurrence in the Remnant Pancreas Following Radical Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Pooled Analysis.
Journal of clinical medicine, 2020Co-Authors: Munseok Choi, Woo Jung Lee, Na Won Kim, Ho Kyoung Hwang, Chang Moo KangAbstract:The mainstream treatment for recurrent pancreatic cancer is potent chemotherapy or chemoradiotherapy. However, recent clinical investigations have suggested a potential oncologic role of local resection of recurrent pancreatic cancer. This systemic review with a pooled analysis aimed to assess the potential role of local repeated Pancreatectomy with respect to the survival outcomes for patients with recurrent pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas. The PubMed database was searched, and 15 articles reporting on repeated Pancreatectomy for local recurrence of PDAC in the remnant pancreas were identified. The pooled individual data were examined for the clinical outcomes of repeated Pancreatectomy for recurrent PDAC. The survival analysis was performed using the Kaplan–Meier method. In the pooled analysis, the mean time interval from initial Pancreatectomy to repeated Pancreatectomy was 41.3 months (standard deviation (SD), 29.09 months). Completion total Pancreatectomy was most commonly performed as repeated Pancreatectomy (46 patients, 92.0%), and partial pancreatic resection was performed for only 4 (10.3%) patients. Twenty (40.9%) patients received postoperative chemotherapy following repeated Pancreatectomy. The median overall survival was 60 months (95% confidential interval (CI): 45.99–74.01) after repeated Pancreatectomy for isolated local recurrence in the remnant pancreas. Overall survival was markedly longer considering the timing of the initial Pancreatectomy for pancreatic cancer (median, 107 months (95% CI: 80.37–133.62). The time interval between the initial and subsequent repeated Pancreatectomy for pancreatic cancer was not associated with long-term oncologic outcomes (p = 0.254). Repeated Pancreatectomy cannot completely replace adjuvant chemotherapy but should be considered for patients with isolated local recurrent PDAC in the remnant pancreas.
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Safety and Feasibility of Robotic Reduced-Port Distal Pancreatectomy: a Multicenter Experience of a Novel Technique
Journal of Gastrointestinal Surgery, 2019Co-Authors: Guisuk Park, Sung Hoon Choi, Chang Moo KangAbstract:Background A reduced-port approach including single-site surgery has been used for distal Pancreatectomy. However, triangulation is difficult in reduced-port laparoscopic distal Pancreatectomy, and instrument crowding, and collision may occur, so this approach has not been widely used. Recently, an innovative technique for distal Pancreatectomy using a robotic single-site surgical system was introduced. Herein, we evaluate the safety and feasibility of this technique. Methods Twenty-seven patients with a pancreatic tail mass underwent robotic single-site plus one-port distal Pancreatectomy at six centers. We collected clinicopathologic data and evaluated the short-term perioperative outcomes of robotic single-site plus one-port distal Pancreatectomy. Results We evaluated 26 patients who underwent robotic single-site plus one-port distal Pancreatectomy excluding one patient who needed more ports because of fatty abdomen. The mean age and body mass index were 47.3 years (range 21–74) and 22.6 kg/m^2 (range 15.8–28.8), respectively. The most common pathologic diagnosis was solid papillary neoplasm followed by a neuroendocrine tumor. The mean operating time was 201 min. The mean length of hospital stay after surgery was 7 days (range 4–10). The rate of spleen preservation was 34.6% (9/26). Six patients had postoperative pancreatic fistula (POPF) grade A, and no patients had POPF grade B or C. Only one patient had class II morbidity. Conclusion Robotic single-site plus one-port distal Pancreatectomy is safe and feasible in terms of short-term outcomes. This technique could be performed in select cases to expand the surgical boundaries of the robotic single-site platform. Further studies are needed with more cases to investigate long-term outcomes.
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Laparoscopic Distal Pancreatectomy for Pancreatic Cancer
Innovation of Diagnosis and Treatment for Pancreatic Cancer, 2017Co-Authors: Chang Moo KangAbstract:Laparoscopic distal Pancreatectomy is regarded as safe and effective in treating benign and borderline malignant pancreatic tumor. It is still controversial to make laparoscopic radical distal Pancreatectomy routine in clinical oncology. However, there are emerging indirect clinical evidences suggesting laparoscopic radical distal Pancreatectomy can produce favorable oncologic outcomes in selected patients. Unlike pancreatic head cancer, surgical process for complicated reconstruction is not necessary in minimally invasive approach to distal pancreatic cancer. Therefore, laparoscopic distal Pancreatectomy has potential room for standardized surgical approach in well selected left-sided pancreatic cancer. In addition, owing to minimally invasive approach, it is also expected to enhance the patients’ postoperative recovery and make the patients start early postoperative adjuvant chemotherapy. In this chapter, rationales, feasibility, surgical concept, clinical evidences, and interesting issues related to laparoscopic radical distal Pancreatectomy will be discussed.
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Laparoscopic-assisted spleen-preserving and pylorus-preserving total Pancreatectomy for main duct type intraductal papillary mucinous tumors of the pancreas: a case report.
Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2011Co-Authors: Dong Hyun Kim, Chang Moo Kang, Woo Jung LeeAbstract:Minimally invasive and function-preserving Pancreatectomy would be the ideal approach for benign and borderline malignant tumors of the pancreas. Total Pancreatectomy can be indicated for the main duct type of intraductal papillary mucin-producing tumor (IPMT) to achieve radical resection. Recently, several studies advocating total Pancreatectomy in IPMT have been published, but they are all believed to be done by conventional laparotomy. Herein, we report a case of a 72-year-old female patient who successfully underwent laparoscopic-assisted total Pancreatectomy with the spleen and pylorus preserved in borderline malignant main duct type IPMT. A marginal ulcer around the duodenojejunostomy was developed, but managed by a proton-pump inhibitor. She was discharged 20 days after surgery. She was followed for more than 2 years without evidence of tumor recurrence. Her blood sugar level was well controlled by insulin pump therapy and image study showed well-preserved spleen function.
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detrimental effect of postoperative complications on oncologic efficacy of r0 Pancreatectomy in ductal adenocarcinoma of the pancreas
Journal of Gastrointestinal Surgery, 2009Co-Authors: Dong Hyun Kim, Chang Moo Kang, Gi Hong Choi, Kyung Sik Kim, Jin Sub ChoiAbstract:Background Margin-negative resection of pancreatic cancers has proven to be the most effective treatment to date. Although there are frequent surgery-related complications following Pancreatectomy, the oncologic effect of these complications following Pancreatectomy for pancreatic cancer has not been studied.
Chung Ngai Tang - One of the best experts on this subject based on the ideXlab platform.
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Robot-Assisted Laparoscopic Distal Pancreatectomy and Splenectomy
Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, 2015Co-Authors: Eric C.h. Lai, Chung Ngai TangAbstract:In contrast to pancreatoduodenectomy, minimally invasive distal Pancreatectomy is much easier technically, because there is no need for any anastomosis. Most surgeons agree that the conventional laparoscopic approach to distal Pancreatectomy should be considered the standard approach for benign and borderline malignant tumors of the pancreas. A robot-assisted approach provides equivalent safety and similar outcomes, but with the advantage of a shorter learning curve for surgeons less experienced in minimally invasive distal Pancreatectomy.
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Robotic distal Pancreatectomy versus conventional laparoscopic distal Pancreatectomy: a comparative study for short-term outcomes.
Frontiers of medicine, 2015Co-Authors: Eric C.h. Lai, Chung Ngai TangAbstract:Robotic system has been increasingly used in Pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal Pancreatectomy and conventional laparoscopic distal Pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal Pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal Pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal Pancreatectomy.
C. J. H. M. Van Laarhoven - One of the best experts on this subject based on the ideXlab platform.
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Cost-effectiveness of laparoscopic versus open distal Pancreatectomy for pancreatic cancer.
PloS one, 2017Co-Authors: Kurinchi Selvan Gurusamy, Deniece Riviere, C. J. H. M. Van Laarhoven, Marc G. Besselink, Mohammed Abu-hilal, Brian R. Davidson, Steve MorrisAbstract:BACKGROUND: A recent Cochrane review compared laparoscopic versus open distal Pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal Pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal Pancreatectomy versus open distal Pancreatectomy for pancreatic cancer. METHOD: Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken. RESULTS: The probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive ( pound3,708.58 (95% confidence intervals (CI) - pound9,473.62 to pound16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal Pancreatectomy versus open distal Pancreatectomy. The probability laparoscopic distal Pancreatectomy was cost-effective compared to open distal Pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England ( pound20,000 to pound30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time. CONCLUSIONS: There is considerable uncertainty about whether laparoscopic distal Pancreatectomy is cost-effective compared to open distal Pancreatectomy for pancreatic cancer in the NHS setting.
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laparoscopic versus open distal Pancreatectomy for pancreatic cancer
Cochrane Database of Systematic Reviews, 2016Co-Authors: Deniece Riviere, Kurinchi Selvan Gurusamy, Marc G. Besselink, Brian R. Davidson, Charles M. Vollmer, David A Kooby, C. J. H. M. Van LaarhovenAbstract:Background Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal Pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay as compared with open surgery. However, concerns remain about the safety of laparoscopic distal Pancreatectomy compared with open distal Pancreatectomy in terms of postoperative complications and oncological clearance. Objectives To assess the benefits and harms of laparoscopic distal Pancreatectomy versus open distal Pancreatectomy for people undergoing distal Pancreatectomy for pancreatic ductal adenocarcinoma of the body or tail of the pancreas, or both. Search methods We used search strategies to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded and trials registers until June 2015 to identify randomised controlled trials (RCTs) and non-randomised studies. We also searched the reference lists of included trials to identify additional studies. Selection criteria We considered for inclusion in the review RCTs and non-randomised studies comparing laparoscopic versus open distal Pancreatectomy in patients with resectable pancreatic cancer, irrespective of language, blinding or publication status.. Data collection and analysis Two review authors independently identified trials and independently extracted data. We calculated odds ratios (ORs), mean differences (MDs) or hazard ratios (HRs) along with 95% confidence intervals (CIs) using both fixed-effect and random-effects models with RevMan 5 on the basis of intention-to-treat analysis when possible. Main results We found no RCTs on this topic. We included in this review 12 non-randomised studies that compared laparoscopic versus open distal Pancreatectomy (1576 participants: 394 underwent laparoscopic distal Pancreatectomy and 1182 underwent open distal Pancreatectomy); 11 studies (1506 participants: 353 undergoing laparoscopic distal Pancreatectomy and 1153 undergoing open distal Pancreatectomy) provided information for one or more outcomes. All of these studies were retrospective cohort-like studies or case-control studies. Most were at unclear or high risk of bias, and the overall quality of evidence was very low for all reported outcomes. Differences in short-term mortality (laparoscopic group: 1/329 (adjusted proportion based on meta-analysis estimate: 0.5%) vs open group: 11/1122 (1%); OR 0.48, 95% CI 0.11 to 2.17; 1451 participants; nine studies; I2 = 0%), long-term mortality (HR 0.96, 95% CI 0.82 to 1.12; 277 participants; three studies; I2 = 0%), proportion of people with serious adverse events (laparoscopic group: 7/89 (adjusted proportion: 8.8%) vs open group: 6/117 (5.1%); OR 1.79, 95% CI 0.53 to 6.06; 206 participants; three studies; I2 = 0%), proportion of people with a clinically significant pancreatic fistula (laparoscopic group: 9/109 (adjusted proportion: 7.7%) vs open group: 9/137 (6.6%); OR 1.19, 95% CI 0.47 to 3.02; 246 participants; four studies; I2 = 61%) were imprecise. Differences in recurrence at maximal follow-up (laparoscopic group: 37/81 (adjusted proportion based on meta-analysis estimate: 36.3%) vs open group: 59/103 (49.5%); OR 0.58, 95% CI 0.32 to 1.05; 184 participants; two studies; I2 = 13%), adverse events of any severity (laparoscopic group: 33/109 (adjusted proportion: 31.7%) vs open group: 45/137 (32.8%); OR 0.95, 95% CI 0.54 to 1.66; 246 participants; four studies; I2 = 18%) and proportion of participants with positive resection margins (laparoscopic group: 49/333 (adjusted proportion based on meta-analysis estimate: 14.3%) vs open group: 208/1133 (18.4%); OR 0.74, 95% CI 0.49 to 1.10; 1466 participants; 10 studies; I2 = 6%) were also imprecise. Mean length of hospital stay was shorter by 2.43 days in the laparoscopic group than in the open group (MD -2.43 days, 95% CI -3.13 to -1.73; 1068 participants; five studies; I2 = 0%). None of the included studies reported quality of life at any point in time, recurrence within six months, time to return to normal activity and time to return to work or blood transfusion requirements. Authors' conclusions Currently, no randomised controlled trials have compared laparoscopic distal Pancreatectomy versus open distal Pancreatectomy for patients with pancreatic cancers. In observational studies, laparoscopic distal Pancreatectomy has been associated with shorter hospital stay as compared with open distal Pancreatectomy. Currently, no information is available to determine a causal association in the differences between laparoscopic versus open distal Pancreatectomy. Observed differences may be a result of confounding due to laparoscopic operation on less extensive cancer and open surgery on more extensive cancer. In addition, differences in length of hospital stay are relevant only if laparoscopic and open surgery procedures are equivalent oncologically. This information is not available currently. Thus, randomised controlled trials are needed to compare laparoscopic distal Pancreatectomy versus open distal Pancreatectomy with at least two to three years of follow-up. Such studies should include patient-oriented outcomes such as short-term mortality and long-term mortality (at least two to three years); health-related quality of life; complications and the sequelae of complications; resection margins; measures of earlier postoperative recovery such as length of hospital stay, time to return to normal activity and time to return to work (in those who are employed); and recurrence of cancer.
Mohammad Abu Hilal - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic versus open distal Pancreatectomy a clinical and cost effectiveness study
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: Mohammad Abu Hilal, Mohammed Hamdan, Francesco Di Fabio, Neil W Pearce, C D JohnsonAbstract:Background Laparoscopic distal Pancreatectomy (LDP) is being increasingly performed with some concerns regarding the cost of the minimally invasive approach. The purpose of this study was to assess the cost-effectiveness of LDP versus open distal Pancreatectomy (ODP).
Kurinchi Selvan Gurusamy - One of the best experts on this subject based on the ideXlab platform.
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Cost-effectiveness of laparoscopic versus open distal Pancreatectomy for pancreatic cancer.
PloS one, 2017Co-Authors: Kurinchi Selvan Gurusamy, Deniece Riviere, C. J. H. M. Van Laarhoven, Marc G. Besselink, Mohammed Abu-hilal, Brian R. Davidson, Steve MorrisAbstract:BACKGROUND: A recent Cochrane review compared laparoscopic versus open distal Pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal Pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal Pancreatectomy versus open distal Pancreatectomy for pancreatic cancer. METHOD: Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken. RESULTS: The probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive ( pound3,708.58 (95% confidence intervals (CI) - pound9,473.62 to pound16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal Pancreatectomy versus open distal Pancreatectomy. The probability laparoscopic distal Pancreatectomy was cost-effective compared to open distal Pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England ( pound20,000 to pound30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time. CONCLUSIONS: There is considerable uncertainty about whether laparoscopic distal Pancreatectomy is cost-effective compared to open distal Pancreatectomy for pancreatic cancer in the NHS setting.
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laparoscopic versus open distal Pancreatectomy for pancreatic cancer
Cochrane Database of Systematic Reviews, 2016Co-Authors: Deniece Riviere, Kurinchi Selvan Gurusamy, Marc G. Besselink, Brian R. Davidson, Charles M. Vollmer, David A Kooby, C. J. H. M. Van LaarhovenAbstract:Background Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal Pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay as compared with open surgery. However, concerns remain about the safety of laparoscopic distal Pancreatectomy compared with open distal Pancreatectomy in terms of postoperative complications and oncological clearance. Objectives To assess the benefits and harms of laparoscopic distal Pancreatectomy versus open distal Pancreatectomy for people undergoing distal Pancreatectomy for pancreatic ductal adenocarcinoma of the body or tail of the pancreas, or both. Search methods We used search strategies to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded and trials registers until June 2015 to identify randomised controlled trials (RCTs) and non-randomised studies. We also searched the reference lists of included trials to identify additional studies. Selection criteria We considered for inclusion in the review RCTs and non-randomised studies comparing laparoscopic versus open distal Pancreatectomy in patients with resectable pancreatic cancer, irrespective of language, blinding or publication status.. Data collection and analysis Two review authors independently identified trials and independently extracted data. We calculated odds ratios (ORs), mean differences (MDs) or hazard ratios (HRs) along with 95% confidence intervals (CIs) using both fixed-effect and random-effects models with RevMan 5 on the basis of intention-to-treat analysis when possible. Main results We found no RCTs on this topic. We included in this review 12 non-randomised studies that compared laparoscopic versus open distal Pancreatectomy (1576 participants: 394 underwent laparoscopic distal Pancreatectomy and 1182 underwent open distal Pancreatectomy); 11 studies (1506 participants: 353 undergoing laparoscopic distal Pancreatectomy and 1153 undergoing open distal Pancreatectomy) provided information for one or more outcomes. All of these studies were retrospective cohort-like studies or case-control studies. Most were at unclear or high risk of bias, and the overall quality of evidence was very low for all reported outcomes. Differences in short-term mortality (laparoscopic group: 1/329 (adjusted proportion based on meta-analysis estimate: 0.5%) vs open group: 11/1122 (1%); OR 0.48, 95% CI 0.11 to 2.17; 1451 participants; nine studies; I2 = 0%), long-term mortality (HR 0.96, 95% CI 0.82 to 1.12; 277 participants; three studies; I2 = 0%), proportion of people with serious adverse events (laparoscopic group: 7/89 (adjusted proportion: 8.8%) vs open group: 6/117 (5.1%); OR 1.79, 95% CI 0.53 to 6.06; 206 participants; three studies; I2 = 0%), proportion of people with a clinically significant pancreatic fistula (laparoscopic group: 9/109 (adjusted proportion: 7.7%) vs open group: 9/137 (6.6%); OR 1.19, 95% CI 0.47 to 3.02; 246 participants; four studies; I2 = 61%) were imprecise. Differences in recurrence at maximal follow-up (laparoscopic group: 37/81 (adjusted proportion based on meta-analysis estimate: 36.3%) vs open group: 59/103 (49.5%); OR 0.58, 95% CI 0.32 to 1.05; 184 participants; two studies; I2 = 13%), adverse events of any severity (laparoscopic group: 33/109 (adjusted proportion: 31.7%) vs open group: 45/137 (32.8%); OR 0.95, 95% CI 0.54 to 1.66; 246 participants; four studies; I2 = 18%) and proportion of participants with positive resection margins (laparoscopic group: 49/333 (adjusted proportion based on meta-analysis estimate: 14.3%) vs open group: 208/1133 (18.4%); OR 0.74, 95% CI 0.49 to 1.10; 1466 participants; 10 studies; I2 = 6%) were also imprecise. Mean length of hospital stay was shorter by 2.43 days in the laparoscopic group than in the open group (MD -2.43 days, 95% CI -3.13 to -1.73; 1068 participants; five studies; I2 = 0%). None of the included studies reported quality of life at any point in time, recurrence within six months, time to return to normal activity and time to return to work or blood transfusion requirements. Authors' conclusions Currently, no randomised controlled trials have compared laparoscopic distal Pancreatectomy versus open distal Pancreatectomy for patients with pancreatic cancers. In observational studies, laparoscopic distal Pancreatectomy has been associated with shorter hospital stay as compared with open distal Pancreatectomy. Currently, no information is available to determine a causal association in the differences between laparoscopic versus open distal Pancreatectomy. Observed differences may be a result of confounding due to laparoscopic operation on less extensive cancer and open surgery on more extensive cancer. In addition, differences in length of hospital stay are relevant only if laparoscopic and open surgery procedures are equivalent oncologically. This information is not available currently. Thus, randomised controlled trials are needed to compare laparoscopic distal Pancreatectomy versus open distal Pancreatectomy with at least two to three years of follow-up. Such studies should include patient-oriented outcomes such as short-term mortality and long-term mortality (at least two to three years); health-related quality of life; complications and the sequelae of complications; resection margins; measures of earlier postoperative recovery such as length of hospital stay, time to return to normal activity and time to return to work (in those who are employed); and recurrence of cancer.
