BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to...BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.展开更多
BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary...BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.展开更多
AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who under...AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who underwent PD.According to the number of PDs undertaken per year,we categorized the volume into low volume(< 10 PDs/year),medium volume(10-24 PDs/year) and high volume(> 25 PDs/year) groups.RESULTS From 2002 to 2013,200 patients underwent PD.The annual number of PD increased from 4 in 2002 to 34 in 2013.The mean operative time,operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories(P < 0.001,P < 0.001 and P < 0.001,respectively).Increased procedural volume was associated with a lower morbidity(P = 0.021) and shorter length of hospital stay(P < 0.001).Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group(P = 0.007).CONCLUSION The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.展开更多
文摘BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
文摘BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.
文摘BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.
文摘AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who underwent PD.According to the number of PDs undertaken per year,we categorized the volume into low volume(< 10 PDs/year),medium volume(10-24 PDs/year) and high volume(> 25 PDs/year) groups.RESULTS From 2002 to 2013,200 patients underwent PD.The annual number of PD increased from 4 in 2002 to 34 in 2013.The mean operative time,operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories(P < 0.001,P < 0.001 and P < 0.001,respectively).Increased procedural volume was associated with a lower morbidity(P = 0.021) and shorter length of hospital stay(P < 0.001).Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group(P = 0.007).CONCLUSION The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.
