Pancreaticoduodenectomy

14,000,000 Leading Edge Experts on the ideXlab platform

Scan Science and Technology

Contact Leading Edge Experts & Companies

Scan Science and Technology

Contact Leading Edge Experts & Companies

The Experts below are selected from a list of 24687 Experts worldwide ranked by ideXlab platform

John L. Cameron - One of the best experts on this subject based on the ideXlab platform.

  • clinicopathologic analysis of ampullary neoplasms in 450 patients implications for surgical strategy and long term prognosis
    Journal of Gastrointestinal Surgery, 2010
    Co-Authors: Jordan M. Winter, Ralph H. Hruban, John L. Cameron, Barish H. Edil, Kelly Olino, Joseph M Herman, Mechteld C De Jong, Christopher L Wolfgang, Frederic E Eckhauser, Michael A. Choti
    Abstract:

    Background Whether ampullary neoplasms are best surgically managed by Pancreaticoduodenectomy versus local ampullectomy is controversial. We sought to examine the outcome of patients undergoing Pancreaticoduodenectomy versus ampullectomy, as well as to identify factors predictive of lymph node metastasis in patients with ampullary neoplasms.

  • Incidence and outcome of biliary strictures after Pancreaticoduodenectomy
    Annals of surgery, 2006
    Co-Authors: Michael G. House, Joann Coleman, Patricia K. Sauter, John L. Cameron, Keith D. Lillemoe, Richard D. Schulick, Kurt A. Campbell, Charles J. Yeo
    Abstract:

    Advances in operative technique and postoperative care have resulted in a decrease in the substantial mortality that was once associated with Pancreaticoduodenectomy. However, despite the many improvements in clinical management of patients undergoing Pancreaticoduodenectomy, postoperative complications remain frequent.1–4 Reports from large-volume pancreatic surgery centers have focused mainly on the early postoperative complications after Pancreaticoduodenectomy, such as delayed gastric emptying, pancreaticocutaneous fistula, and surgical site infection.1,2,5,6 Few studies have examined the postoperative complications that present after hospital discharge.7 The purposes of this retrospective study were to determine the late incidence of biliary stricture formation after Pancreaticoduodenectomy for benign and malignant diseases, to determine the etiology and risk factors for stricture formation, and to review our clinical experience with managing this complication.

  • does fibrin glue sealant decrease the rate of pancreatic fistula after Pancreaticoduodenectomy results of a prospective randomized trial
    Journal of Gastrointestinal Surgery, 2004
    Co-Authors: Kurtis A. Campbell, Patricia K. Sauter, John L. Cameron, Keith D. Lillemoe, Joann Coleman
    Abstract:

    Despite substantial improvements in perioperative mortality, complications, and specifically the development of a pancreatic fistula, remain a common occurrence after Pancreaticoduodenectomy. It was the objective of this study to evaluate the role of fibrin glue sealant as an adjunct to decrease the rate of pancreatic fistula after Pancreaticoduodenectomy. One hundred twenty-five patients were randomized after pancreaticoduodenal resection only if, in the opinion of the surgeon, the pancreaticojejunal anastomosis was at high risk for development of a pancreatic anastomotic leak. After completion of the pancreaticojejunal anastomosis, the patients were randomized to topical application of fibrin glue sealant to the surface of the anastomosis or no such application. The primary postoperative end points in this study were pancreatic fistula, total complications, death, and length of hospital stay. A total of 59 patients were randomized to the fibrin glue arm, whereas 66 patients were randomized to the control arm and did not receive fibrin glue application. The pancreatic fistula rate in the fibrin glue arm of the study was 26% vs. 30% in the control group (p = not significant [NS]). The mean length of postoperative stay for all patients randomized was similar (fibrin glue = 12.2 days, control = 13.6 days) and the mean length of stay for patients in whom pancreatic fistula developed was also not different (fibrin glue = 18.9 days, control = 21.7 days). There were no differences with respect to total complications or specific complications such as postoperative bleeding, infection, or delayed gastric emptying. These data demonstrate that the topical application of fibrin glue sealant to the surface of the pancreatic anastomosis in this patient population undergoing high-risk pancreaticojejunal anastomosis did not reduce the incidence of pancreatic fistula or total complications after pancreaticodudodenectomy. There seems to be no benefit regarding the use of this substance in this setting.

  • Standard vs. radical Pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in Pancreaticoduodenectomy survivors
    Journal of Gastrointestinal Surgery, 2003
    Co-Authors: Tom C. Nguyen, Joann Coleman, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Kurtis A. Campbell, John L. Cameron, Keith D. Lillemoe, Ralph H. Hruban
    Abstract:

    This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical Pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard Pancreaticoduodenectomy (pylorus preservation preferred) to radical Pancreaticoduodenectomy (including distal gastrectomy and ret-roperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving Pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after Pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men 66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P < 0.001), and a longer postoperative length of hospital stay (13.6 days vs. 10.1 days; P < 0.01). The FACT-Hep total QOL scores were similar between the standard and radical groups: 143.5 vs. 147.3, respectively. Additionally, the individual FACT-G subscale scores evaluating physical (22.1 vs. 23.3), social (24.5 vs. 24.4), emotional (19.2 vs. 19.6), and functional well-being (20.6 vs. 22.4) were comparable between the standard and radical groups. Subgroup analyses based on pathologic diagnosis (pancreatic, ampullary, distal bile duct, etc.) failed to reveal any differences in QOL assessment between the standard and radical Pancreaticoduodenectomy groups. Finally, QOL measures were similar when comparing time since operation (2 years’ follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of Pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical Pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.

  • Standard vs. radical Pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in Pancreaticoduodenectomy survivors
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2003
    Co-Authors: Tom C. Nguyen, Joann Coleman, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Ralph H. Hruban, Kurtis A. Campbell, John L. Cameron, Keith D. Lillemoe, Charles J. Yeo
    Abstract:

    This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical Pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard Pancreaticoduodenectomy (pylorus preservation preferred) to radical Pancreaticoduodenectomy (including distal gastrectomy and ret-roperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving Pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after Pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men 66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P 2 years’ follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of Pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical Pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.

Barish H. Edil - One of the best experts on this subject based on the ideXlab platform.

Keith D. Lillemoe - One of the best experts on this subject based on the ideXlab platform.

  • Incidence and outcome of biliary strictures after Pancreaticoduodenectomy
    Annals of surgery, 2006
    Co-Authors: Michael G. House, Joann Coleman, Patricia K. Sauter, John L. Cameron, Keith D. Lillemoe, Richard D. Schulick, Kurt A. Campbell, Charles J. Yeo
    Abstract:

    Advances in operative technique and postoperative care have resulted in a decrease in the substantial mortality that was once associated with Pancreaticoduodenectomy. However, despite the many improvements in clinical management of patients undergoing Pancreaticoduodenectomy, postoperative complications remain frequent.1–4 Reports from large-volume pancreatic surgery centers have focused mainly on the early postoperative complications after Pancreaticoduodenectomy, such as delayed gastric emptying, pancreaticocutaneous fistula, and surgical site infection.1,2,5,6 Few studies have examined the postoperative complications that present after hospital discharge.7 The purposes of this retrospective study were to determine the late incidence of biliary stricture formation after Pancreaticoduodenectomy for benign and malignant diseases, to determine the etiology and risk factors for stricture formation, and to review our clinical experience with managing this complication.

  • does fibrin glue sealant decrease the rate of pancreatic fistula after Pancreaticoduodenectomy results of a prospective randomized trial
    Journal of Gastrointestinal Surgery, 2004
    Co-Authors: Kurtis A. Campbell, Patricia K. Sauter, John L. Cameron, Keith D. Lillemoe, Joann Coleman
    Abstract:

    Despite substantial improvements in perioperative mortality, complications, and specifically the development of a pancreatic fistula, remain a common occurrence after Pancreaticoduodenectomy. It was the objective of this study to evaluate the role of fibrin glue sealant as an adjunct to decrease the rate of pancreatic fistula after Pancreaticoduodenectomy. One hundred twenty-five patients were randomized after pancreaticoduodenal resection only if, in the opinion of the surgeon, the pancreaticojejunal anastomosis was at high risk for development of a pancreatic anastomotic leak. After completion of the pancreaticojejunal anastomosis, the patients were randomized to topical application of fibrin glue sealant to the surface of the anastomosis or no such application. The primary postoperative end points in this study were pancreatic fistula, total complications, death, and length of hospital stay. A total of 59 patients were randomized to the fibrin glue arm, whereas 66 patients were randomized to the control arm and did not receive fibrin glue application. The pancreatic fistula rate in the fibrin glue arm of the study was 26% vs. 30% in the control group (p = not significant [NS]). The mean length of postoperative stay for all patients randomized was similar (fibrin glue = 12.2 days, control = 13.6 days) and the mean length of stay for patients in whom pancreatic fistula developed was also not different (fibrin glue = 18.9 days, control = 21.7 days). There were no differences with respect to total complications or specific complications such as postoperative bleeding, infection, or delayed gastric emptying. These data demonstrate that the topical application of fibrin glue sealant to the surface of the pancreatic anastomosis in this patient population undergoing high-risk pancreaticojejunal anastomosis did not reduce the incidence of pancreatic fistula or total complications after pancreaticodudodenectomy. There seems to be no benefit regarding the use of this substance in this setting.

  • Standard vs. radical Pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in Pancreaticoduodenectomy survivors
    Journal of Gastrointestinal Surgery, 2003
    Co-Authors: Tom C. Nguyen, Joann Coleman, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Kurtis A. Campbell, John L. Cameron, Keith D. Lillemoe, Ralph H. Hruban
    Abstract:

    This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical Pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard Pancreaticoduodenectomy (pylorus preservation preferred) to radical Pancreaticoduodenectomy (including distal gastrectomy and ret-roperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving Pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after Pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men 66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P < 0.001), and a longer postoperative length of hospital stay (13.6 days vs. 10.1 days; P < 0.01). The FACT-Hep total QOL scores were similar between the standard and radical groups: 143.5 vs. 147.3, respectively. Additionally, the individual FACT-G subscale scores evaluating physical (22.1 vs. 23.3), social (24.5 vs. 24.4), emotional (19.2 vs. 19.6), and functional well-being (20.6 vs. 22.4) were comparable between the standard and radical groups. Subgroup analyses based on pathologic diagnosis (pancreatic, ampullary, distal bile duct, etc.) failed to reveal any differences in QOL assessment between the standard and radical Pancreaticoduodenectomy groups. Finally, QOL measures were similar when comparing time since operation (2 years’ follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of Pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical Pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.

  • Standard vs. radical Pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in Pancreaticoduodenectomy survivors
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2003
    Co-Authors: Tom C. Nguyen, Joann Coleman, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Ralph H. Hruban, Kurtis A. Campbell, John L. Cameron, Keith D. Lillemoe, Charles J. Yeo
    Abstract:

    This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical Pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard Pancreaticoduodenectomy (pylorus preservation preferred) to radical Pancreaticoduodenectomy (including distal gastrectomy and ret-roperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving Pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after Pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men 66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P 2 years’ follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of Pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical Pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.

  • Should Pancreaticoduodenectomy be performed in octogenarians
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 1998
    Co-Authors: Taylor A. Sohn, Joann Coleman, Patricia K. Sauter, Ralph H. Hruban, John L. Cameron, Keith D. Lillemoe, Charles J. Yeo, Mark A. Talamini, Sarah E. Ord, Louise B. Grochow
    Abstract:

    As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing Pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, Pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%), distal bile duct adenocarcinoma (n = 5; 1 l%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing Pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of Pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreati-coduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 4.54; P = 0.77). These data demonstrate that Pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to Pancreaticoduodenectomy.

Ralph H. Hruban - One of the best experts on this subject based on the ideXlab platform.

  • clinicopathologic analysis of ampullary neoplasms in 450 patients implications for surgical strategy and long term prognosis
    Journal of Gastrointestinal Surgery, 2010
    Co-Authors: Jordan M. Winter, Ralph H. Hruban, John L. Cameron, Barish H. Edil, Kelly Olino, Joseph M Herman, Mechteld C De Jong, Christopher L Wolfgang, Frederic E Eckhauser, Michael A. Choti
    Abstract:

    Background Whether ampullary neoplasms are best surgically managed by Pancreaticoduodenectomy versus local ampullectomy is controversial. We sought to examine the outcome of patients undergoing Pancreaticoduodenectomy versus ampullectomy, as well as to identify factors predictive of lymph node metastasis in patients with ampullary neoplasms.

  • Standard vs. radical Pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in Pancreaticoduodenectomy survivors
    Journal of Gastrointestinal Surgery, 2003
    Co-Authors: Tom C. Nguyen, Joann Coleman, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Kurtis A. Campbell, John L. Cameron, Keith D. Lillemoe, Ralph H. Hruban
    Abstract:

    This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical Pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard Pancreaticoduodenectomy (pylorus preservation preferred) to radical Pancreaticoduodenectomy (including distal gastrectomy and ret-roperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving Pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after Pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men 66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P < 0.001), and a longer postoperative length of hospital stay (13.6 days vs. 10.1 days; P < 0.01). The FACT-Hep total QOL scores were similar between the standard and radical groups: 143.5 vs. 147.3, respectively. Additionally, the individual FACT-G subscale scores evaluating physical (22.1 vs. 23.3), social (24.5 vs. 24.4), emotional (19.2 vs. 19.6), and functional well-being (20.6 vs. 22.4) were comparable between the standard and radical groups. Subgroup analyses based on pathologic diagnosis (pancreatic, ampullary, distal bile duct, etc.) failed to reveal any differences in QOL assessment between the standard and radical Pancreaticoduodenectomy groups. Finally, QOL measures were similar when comparing time since operation (2 years’ follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of Pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical Pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.

  • Standard vs. radical Pancreaticoduodenectomy for periampullary adenocarcinoma: A prospective, randomized trial evaluating quality of life in Pancreaticoduodenectomy survivors
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2003
    Co-Authors: Tom C. Nguyen, Joann Coleman, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Ralph H. Hruban, Kurtis A. Campbell, John L. Cameron, Keith D. Lillemoe, Charles J. Yeo
    Abstract:

    This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical Pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard Pancreaticoduodenectomy (pylorus preservation preferred) to radical Pancreaticoduodenectomy (including distal gastrectomy and ret-roperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving Pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after Pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men 66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P 2 years’ follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of Pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical Pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.

  • Should Pancreaticoduodenectomy be performed in octogenarians
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 1998
    Co-Authors: Taylor A. Sohn, Joann Coleman, Patricia K. Sauter, Ralph H. Hruban, John L. Cameron, Keith D. Lillemoe, Charles J. Yeo, Mark A. Talamini, Sarah E. Ord, Louise B. Grochow
    Abstract:

    As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing Pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, Pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%), distal bile duct adenocarcinoma (n = 5; 1 l%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing Pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of Pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreati-coduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 4.54; P = 0.77). These data demonstrate that Pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to Pancreaticoduodenectomy.

  • Pancreaticoduodenectomy: Does it have a role in the palliation of pancreatic cancer?
    Annals of surgery, 1996
    Co-Authors: Keith D. Lillemoe, Taylor A. Sohn, Patricia K. Sauter, Ross A. Abrams, Ralph H. Hruban, John L. Cameron, Charles J. Yeo, Atilla Nakeeb, Henry A. Pitt
    Abstract:

    OBJECTIVE: The authors define the role of palliative Pancreaticoduodenectomy in patients with pancreatic carcinoma. BACKGROUND: Decreases in perioperative morbidity and mortality and improved long-term survival associated with Pancreaticoduodenectomy for patients with pancreatic carcinoma have clearly established a role for this operation when performed with curative intent. However, most surgeons remain hesitant to perform Pancreaticoduodenectomy unless surgical margins are widely clear, choosing rather to perform palliative biliary and gastric bypass. METHODS: A single-institution retrospective review was performed comparing the outcome of 64 consecutive patients undergoing Pancreaticoduodenectomy for pancreatic carcinoma with gross or microscopic evidence of adenocarcinoma at the surgical resection margins, and 62 consecutive patients found to be unresectable at the time of laparotomy because of local invasion without evidence of metastatic disease (stage III). Combined biliary and gastric bypass were performed in 87% of patients not resected. RESULTS: The two groups were similar with respect to age, gender, race, and presenting symptoms. The hospital mortality rate was identical in both groups (1.6%). Fifty-eight percent of patients undergoing Pancreaticoduodenectomy had an uncomplicated postoperative course compared with 68% of patients undergoing palliative bypass (not significant). The length of postoperative hospital stay after Pancreaticoduodenectomy was 18.4 days, which was significantly longer (p < 0.05) than for patients undergoing palliative bypass (15.0 days). The overall actuarial survival (Kaplan-Meier) was improved significantly in patients undergoing Pancreaticoduodenectomy (p < 0.02). Postoperative chemotherapy and radiation therapy improved survival in both groups. CONCLUSIONS: Pancreaticoduodenectomy can be performed with a similar perioperative morbidity and mortality and only a minimal increase in hospital stay when compared with traditional surgical palliation. Pancreaticoduodenectomy with postoperative chemotherapy and radiation therapy is associated with improved long-term survival when compared with patients treated with surgical bypass. These data support the role of palliative Pancreaticoduodenectomy in patients with pancreatic carcinoma and with local residual disease.

Michael B. Farnell - One of the best experts on this subject based on the ideXlab platform.

  • Pancreaticoduodenectomy with major vascular resection a comparison of laparoscopic versus open approaches
    Journal of Gastrointestinal Surgery, 2015
    Co-Authors: Kris P Croome, Michael B. Farnell, Florencia G Que, Kmarie Reidlombardo, Mark J Truty, David M Nagorney, Michael L Kendrick
    Abstract:

    Background Major vascular resection when necessary for margin control during Pancreaticoduodenectomy is relatively universal with perioperative and oncological outcomes that are similar to those of patients undergoing a PD without venous involvement. The present study compares total laparoscopic Pancreaticoduodenectomy (TLPD) versus open Pancreaticoduodenectomy (OPD) with major vascular resection.

  • total laparoscopic Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma oncologic advantages over open approaches
    Annals of Surgery, 2014
    Co-Authors: Kristopher P Croome, Michael B. Farnell, Florencia G Que, Kmarie Reidlombardo, Mark J Truty, David M Nagorney, Michael L Kendrick
    Abstract:

    Objective:To directly compare the oncologic outcomes of TLPD and OPD in the setting of pancreatic ductal adenocarcinoma.Background:Total laparoscopic Pancreaticoduodenectomy (TLPD) has been demonstrated to be feasible and may have several potential advantages over open Pancreaticoduodenectomy (OPD),

  • pancreatic anastomotic leakage after Pancreaticoduodenectomy in 1 507 patients a report from the pancreatic anastomotic leak study group
    Journal of Gastrointestinal Surgery, 2007
    Co-Authors: Kaye M Reidlombardo, Michael B. Farnell, Stefano Crippa, Matthew J Barnett, George Maupin, Claudio Bassi, William L Traverso
    Abstract:

    Several definitions for pancreatic leakage after pancreaticodoudenectomy exist, and the reported range of 2–50% underscores this variation. The goal was to determine if drain data alone was predictive of a leak and validate International Study Group on Pancreatic Fistula (ISGPF) leak criteria. Participating surgeons entered de-identified data into a web-based database designed to collect Whipple-related data. Definitions used were the ISGPF definition, ≥3 days, amylase 3× normal; and Sarr’s definition, ≥5 days, amylase 5× normal, >30 ml. We compared how well these two definitions were at detecting a leak and its complications. There were 1,507 cases submitted from 16 international institutions. A Pancreaticoduodenectomy (PPPD) was performed in 76.2%. Drain placement occurred in 98.0%. Using the ISGPF definition, the pancreatic leak rate was 26.7 and 14.3% with the Sarr definition. There were more grades A and B leaks detected by the ISGPF definition. Both determined grade C leaks equally. Both definitions correlated with an increased length of stay (LOS), need for percutaneous drains, reoperation, and delayed gastric emptying (DGE). Neither was associated with an increased risk of intensive care unit (ICU) stay or 30-day mortality. The ISGPF was able to capture more patients with clinically relevant leaks than Sarr’s criteria; however, the ability to detect a leak by drain data alone is imperfect.

  • An Innovative Option for Venous Reconstruction After Pancreaticoduodenectomy: the Left Renal Vein
    Journal of Gastrointestinal Surgery, 2007
    Co-Authors: Rory L. Smoot, John D. Christein, Michael B. Farnell
    Abstract:

    Introduction Pancreatic ductal adenocarcinoma has a high mortality rate with limited treatment options. One option is Pancreaticoduodenectomy, although complete resection may require venous resection. Pancreaticoduodenectomy with venous resection and reconstruction is becoming a more common practice with many choices for venous reconstruction. We describe the technique of using the left renal vein as a conduit for venous reconstruction during Pancreaticoduodenectomy.

Related terms

Pancreaticoduodenectomy - 15 days free trial to Access Experts & Abstracts