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Jeon SM, Choi YJ, Jo HS, Choi SB, Kim WB, Han HJ, Song TJ, Kim DS, Yu YD. Oncologic effect of preoperative endoscopic sphincterotomy in patients undergoing pancreaticoduodenectomy for ampulla of vater cancer. Langenbecks Arch Surg 2025; 410:161. [PMID: 40377694 DOI: 10.1007/s00423-025-03730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 05/06/2025] [Indexed: 05/18/2025]
Abstract
PURPOSE Ampulla of Vater (AoV) cancer often presents with bile flow obstruction requiring bile drainage. Endoscopic sphincterotomy (EST) for AoV cancer may result in inflammation and spread of the tumor due to the abundant lymphatic channels and microvascular structures around the AoV, which may impact the postoperative and oncologic outcomes. This study aimed to evaluate the postoperative and oncological effects of EST on AoV cancer. METHODS Medical records of 131 patients with AoV cancer who underwent pancreaticoduodeenectomy between 2011 and 2020 were reviewed. We compared the perioperative outcomes, overall survival, and disease recurrence in the patients. RESULTS Approximately 71 patients underwent EST for preoperative biliary drainage, whereas 60 did not receive any procedure or underwent percutaneous transhepatic biliary drainage. No significant differences were observed in the 5-year overall survival rate (EST 69.9% vs. no EST 75.1%, P = 0.804) or the 5-year cumulative recurrence rate (EST 49.1% vs. no EST 56.8%, P = 0.855). However, in subgroup analysis using the T stage, EST was associated with reduced 5-year overall survival in the T3 and T4 stages (EST 34.8% vs. no EST 78.0%: P = 0.038). CONCLUSION AND DISCUSSION Preoperative endoscopic intervention for AoV cancer did not affect oncologic outcomes. However, in the advanced stage, direct manipulation of cancer may result in lower overall survival, requiring careful consideration for preoperative biliary drainage.
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Affiliation(s)
- Su Min Jeon
- Division of HBP Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Yoo Jin Choi
- Division of HBP Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Hye-Sung Jo
- Division of HBP Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Sae Byeol Choi
- Division of HBP Surgery, Department of Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Wan-Bae Kim
- Division of HBP Surgery, Department of Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Hyung-Joon Han
- Division of HBP Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Tae Jin Song
- Division of HBP Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Dong-Sik Kim
- Division of HBP Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Young-Dong Yu
- Division of HBP Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, College of Medicine, Korea University, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea.
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Niu W, Zhang Y, Wu J. Letter to the editor on "Prognostic relevance of lymph node metastasis in pancreaticoduodenectomy for distal cholangiocarcinoma: Rational extent and number-based nodal classification for regional lymphadenectomy". Surgery 2025:109341. [PMID: 40374404 DOI: 10.1016/j.surg.2025.109341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Accepted: 03/05/2025] [Indexed: 05/17/2025]
Affiliation(s)
- Weiqiao Niu
- Department of Hepatobiliary Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, Jiangsu, China
| | - Yan Zhang
- Department of Hepatobiliary Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, Jiangsu, China
| | - Jianwu Wu
- Department of Hepatobiliary Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, Jiangsu, China.
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Li Y, Pu S, Zong K, Liao R, Huang Z, Huang J, Liu Y, Zhou B, Wu Z. Impact of serum bilirubin levels and preoperative biliary drainage on perioperative complications of pancreaticoduodenectomy. Front Med (Lausanne) 2025; 12:1535106. [PMID: 40438358 PMCID: PMC12116578 DOI: 10.3389/fmed.2025.1535106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 04/30/2025] [Indexed: 06/01/2025] Open
Abstract
Background The effect of elevated preoperative serum bilirubin on complications after pancreaticoduodenectomy (PD) remains uncertain. Preoperative biliary drainage (PBD) effectively reduces serum bilirubin values; however, its impact on PD complications remains debatable. Methods We conducted a retrospective analysis on patients who underwent PD at the First Affiliated Hospital of Chongqing Medical University from October 2018 to July 2023. Patients were categorized into quartiles based on preoperative serum bilirubin levels. Multivariable logistic regression was used to investigate the relationship between bilirubin and the risk of PD complications. Restricted cubic spline (RCS) analysis was conducted to assess the dose-response relationship between bilirubin levels and PD complications. Furthermore, a 3-way interaction of PD complications, preoperative serum bilirubin, and PBD was examined. Results A total of 326 patients participated in the study. Multivariate logistic regression analysis revealed that higher preoperative serum bilirubin levels increased the likelihood of perioperative PD complications. RCS analysis revealed a significant linear dose-response relationship between bilirubin levels and the risk of PD complications. While PBD did not independently affect PD complications, there was a significant 3-way interaction of PD complications, preoperative serum bilirubin levels, and PBD, indicating that patients with serum bilirubin values exceeding 10 times the upper limit of normal (≥ 171 μmol/L) exhibited a lower risk of complications through PBD. Conclusion Elevated preoperative serum bilirubin increases the risk of complications after PD. Patients with high preoperative serum bilirubin values (≥ 171 μmol/L) undergoing PD benefit from PBD.
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Affiliation(s)
- Yilan Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sicheng Pu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kezhen Zong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zuotian Huang
- Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jianbo Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yawen Liu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Baoyong Zhou
- Department of Hepatobiliary Surgery, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongjun Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zhang Y, Yang Y, Li L, Li P. Application of intraluminal brachytherapy for malignant obstruction in the porta hepatis: a retrospective control study. Front Oncol 2025; 15:1416565. [PMID: 40376578 PMCID: PMC12078143 DOI: 10.3389/fonc.2025.1416565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/11/2025] [Indexed: 05/18/2025] Open
Abstract
Purpose and background Malignant obstructions in the porta hepatis mainly include malignant obstructive jaundice (MOJ) and portal vein tumor thrombus (PVTT). Stent placement has been one of the most commonly recommended methods to alleviate the physical suffering of these patients, but the long-term outcome has been frustrating in terms of stent occlusion. The aim of this study was to discuss the clinical effect and technical feasibility of intraluminal brachytherapy (ILBT) in patients with malignant obstruction in the porta hepatis. Methods and materials From 2016 to 2018, 68 patients diagnosed with malignant obstruction in the porta hepatis were retrospectively included in this study. Twenty-eight patients (group A) received stent placement with iodine-125 seed-strand implantation, and 40 patients (group B) received stent placement only. All patients underwent numerous transarterial chemoembolizations (TACE) after stent implantation. All patients were followed up until death. Clinical data, stent patency and survival time were recorded for further analysis. Results There was no significant difference between the two groups in terms of length of malignant obstruction and baseline characteristics. 68 stents were successfully implanted in both groups.Iodine-125 seed strands were successfully deployed and completely covered the length of the stent in group A. Liver function and jaundice improved continuously in the first 9 months after treatment (P<0.05). Compared to group B, the mean stent patency time was significantly longer in group A (5.5 ± 2.09 months versus 6.86 ± 1.82 months, P<0.001). The mean survival time is longer in group A than in patients in group B (10.03 ± 3.04 months VS 7 ± 2.44 months, P<0.001). Conclusion ILBT in combination with stent implantation and TACE has proven to be a feasible and effective palliative treatment to maintain stent patency in patients with PVTT and MOJ.
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Affiliation(s)
- Yi Zhang
- Department of Interventional Therapy, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yang Yang
- Department of Neurology, Luzhou Branch of Changzhi People’s Hospital, Changzhi, Shanxi, China
| | - Lingling Li
- Department of Radiology, Shanghai Pulmonary Hospital of Tongji University, Shanghai, China
| | - Peimin Li
- Department of Interventional Therapy, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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Lin YM, Yu C, Xian GZ. Retrospective analysis of delta hemoglobin and bleeding-related risk factors in pancreaticoduodenectomy. World J Gastrointest Surg 2025; 17:100999. [PMID: 40162429 PMCID: PMC11948129 DOI: 10.4240/wjgs.v17.i3.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 01/07/2025] [Accepted: 02/07/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Objective and accurate assessment of blood loss during pancreaticoduodenectomy (PD) is crucial for ensuring the safety and efficacy of the procedure. While the visual method remains the most common clinical metric, many scholars argue that it significantly differs from actual blood loss and is inherently subjective. AIM To assess blood loss in PD via delta hemoglobin (ΔHb) and compare it with the visual method to predict bleeding-related risk factors. METHODS In this retrospective analysis, 1722 patients who underwent PD from 2017 to 2022 at Shandong Provincial Hospital were divided into three groups: Open PD (OPD), laparoscopic PD (LPD), and conversion to OPD (CTOPD). Intraoperative ΔHb (IΔHb) was calculated via preoperative and 72-hour-postoperative hemoglobin concentrations, and its association with visually obtained estimated blood loss (EBL) was analyzed. Perioperative ΔHb (PΔHb) was calculated via preoperative and predischarge hemoglobin concentrations. We compared the differences in IΔHb and PΔHb among the three groups, and performed univariate and multivariate regression analyses of IΔHb and PΔHb. RESULTS The preoperative general information of patients showed no statistically significant difference among the three groups (P > 0.05). The IΔHb in the OPD, LPD, and CTOPD groups were 22.00 (12.00, 36.00), 21.00 (10.00, 33.00), and 33.00 (18.12, 52.24) g/L, respectively; And the PΔHb in the OPD, LPD, and CTOPD groups were 25.87 (13.51, 42.00), 25.00 (14.00, 45.00), and 37.48 (21.64, 59.65) g/L, respectively, values significantly differed (P < 0.05). IΔHb and EBL were significantly correlated (r = 0.337, P < 0.001). The results of univariate and multivariate regression analyses indicated that American Society of Anesthesiologists (ASA) classification IV [95% confidence interval (CI): 2.330-37.811, P = 0.049] and preoperative total bilirubin > 200 μmol/L (95%CI: 2.805-8.673, P < 0.001) were independent risk factors for IΔHb (P < 0.05), and ASA classification IV (95%CI: 45.934-105.485, P < 0.001), body mass index > 24 kg/m2 (95%CI: 1.285-9.890, P = 0.011), and preoperative total bilirubin > 200 μmol/L (95%CI: 6.948-16.797, P < 0.001) were independent risk factors for PΔHb (P < 0.05). CONCLUSION There is a correlation between IΔHb and EBL in PD, so we can assess the patients' intraoperative blood loss by the ΔHb method. ASA classification IV, body mass index > 24 kg/m², and preoperative total bilirubin > 200 μmol/L increased perioperative bleeding risk.
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Affiliation(s)
- Yi-Min Lin
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Chao Yu
- Department of Emergency Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
| | - Guo-Zhe Xian
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Zhang B, Lang Z, Zhu K, Luo W, Zhao Z, Zhang Z, Wang Z. Whether preoperative biliary drainage leads to better patient outcomes of pancreaticoduodenectomy: a meta-analysis and systematic review. BMC Gastroenterol 2025; 25:161. [PMID: 40069629 PMCID: PMC11900024 DOI: 10.1186/s12876-025-03761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 03/04/2025] [Indexed: 03/14/2025] Open
Abstract
OBJECTIVE To investigate whether preoperative biliary drainage is beneficial for patients undergoing pancreaticoduodenectomy. METHODS The PubMed, Cochrane Library and the Web of Science were systematically searched for relevant trials that included outcome of pancreaticoduodenectomy with and without preoperative biliary drainage from January 2010 to May 2024. The primary outcomes are postoperative pancreatic fistula and intra-abdominal infection. Data is pooled using the risk ratio or standardized mean difference with 95% confidence interval. The study protocol was registered prospectively with PROSPERO (CRD42022372584). RESULTS A total of 39 retrospective cohort studies with 33,516 patients were included in this trial. Compared with no preoperative biliary drainage, the preoperative biliary drainage group had a longer hospital stay (SMD, 0.14). Performing preoperative biliary drainage significantly increases the risk of postoperative pancreatic fistula (RR, 1.09), intra-abdominal infection (RR, 1.09), surgical site infection (RR, 1.84), and sepsis (RR, 1.37). But preoperative biliary drainage lowers risk of bile leak (RR, 0.74). CONCLUSION Preoperative biliary drainage before pancreaticoduodenectomy increases the risk of postoperative complications without clear overall benefits. Routine PBD is not recommended for younger patients with mild to moderate jaundice but may be considered for high-risk patients, such as those with severe infections or progressive jaundice. Optimizing preoperative biliary drainage duration and timing may help reduce complications. Further research is needed to refine patient selection and perioperative strategies.
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Affiliation(s)
- Bo Zhang
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Zekun Lang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Kexiang Zhu
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Wei Luo
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Zhenjie Zhao
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Zeliang Zhang
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Zhengfeng Wang
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China.
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Aeschbacher P, Wenning AS, Katou S, Morgul H, Juratli M, Becker F, Büdeyri I, Gloor B, Pascher A, Struecker B, Andreou A. Impact of Routine and Selective Preoperative Endoscopic Retrograde Cholangiopancreatography with Stent Placement on Postoperative and Oncologic Outcomes Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma. Biomedicines 2025; 13:333. [PMID: 40002746 PMCID: PMC11853506 DOI: 10.3390/biomedicines13020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 01/17/2025] [Accepted: 01/24/2025] [Indexed: 02/27/2025] Open
Abstract
Background: According to current guidelines, preoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting (ERCP/stenting) is often necessary in patients with obstructive jaundice due to pancreatic ductal adenocarcinoma (PDAC), including severe jaundice (bilirubin > 250 umol/l), pruritus, cholangitis, cholestatic liver dysfunction, renal failure, severe malnutrition, or delayed surgery for tumors requiring neoadjuvant chemotherapy. We aimed to investigate the impact of preoperative ERCP/stenting on postoperative and long-term outcomes following pancreaticoduodenectomy (PD) for PDAC. Methods: Clinicopathological data of patients who underwent partial/total PD for PDAC between 2012 and 2019 in two hepato-pancreato-biliary centers in Germany and Switzerland were assessed. We compared patients treated with preoperative ERCP/stenting with those directly undergoing surgery according to postoperative morbidity, postoperative mortality, overall survival (OS) and disease-free survival (DFS). Results: During the study period, 192 patients underwent partial/total PD for PDAC. ERCP/stenting was performed in 105 patients, and 87 patients underwent resection without prior intervention. Postoperative 90-day overall morbidity rate (71% vs. 56%, p = 0.029) and superficial surgical site infection (SSI) rate (39% vs. 17%, p < 0.001) were significantly worse following preoperative ERCP/stenting. Major postoperative morbidity rate (18% vs. 21%, p = 0.650), organ/space SSI rate (7% vs. 14%, p = 0.100), and 90-day postoperative mortality rate (4% vs. 2%, p = 0.549) did not significantly differ between the two groups. After excluding 44 patients for whom the indication for ERCP/stenting was not consistent with current guidelines, ERCP/stenting was associated with a higher superficial SSI rate (36% vs. 17%, p = 0.009) and shorter length of stay (12 vs. 16 days, p = 0.004). Median OS (ERCP/stenting: 18 months vs. no ERCP/stenting: 23 months, p = 0.490) and median DFS (ERCP/stenting: 14 months vs. no ERCP/stenting: 18 months, p = 0.645) were independent from the utilization of ERCP/stenting. Conclusions: Preoperative ERCP/stenting in patients with PDAC can be performed without increasing organ/space SSI, major perioperative morbidity, and mortality rates and without worsening oncologic outcomes. However, it is associated with higher superficial SSI rates. If ERCP/stenting is not performed routinely but according to current guidelines, it is also associated with a shorter length of hospital stay. Further refinement of the indications for preoperative ERCP/stenting may reduce superficial SSI rates.
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Affiliation(s)
- Pauline Aeschbacher
- Department of Visceral Surgery und Medicine, lnselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Anna Silvia Wenning
- Department of Visceral Surgery und Medicine, lnselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Haluk Morgul
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Mazen Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Ibrahim Büdeyri
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Beat Gloor
- Department of Visceral Surgery und Medicine, lnselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Benjamin Struecker
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
| | - Andreas Andreou
- Department of General, Visceral and Transplant Surgery, University Hospital Munster, 48149 Münster, Germany
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Wang W, Zhang C, Li B, Yuan GYL, Zeng ZW. Clinical evaluation of endoscopic biliary stenting in treatment of malignant obstructive jaundice. World J Gastrointest Surg 2025; 17:97596. [PMID: 39872793 PMCID: PMC11757174 DOI: 10.4240/wjgs.v17.i1.97596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 10/23/2024] [Accepted: 11/12/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND Malignant obstructive jaundice (MOJ) is characterized by the presence of malignant tumors infiltrating or compressing the bile duct, causing poor bile drainage, generalized yellowing, pain, itching, and malaise. MOJ is burdensome for both the society and the families of affected patients and should be taken seriously. AIM To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement, complication rates, and long-term patient outcomes. METHODS The clinical data of 59 patients with MOJ who were admitted to our hospital between March 2018 and August 2019 were retrospectively analyzed. According to the treatment method, the patients were divided into an observation group (29 patients) and a control group (30 patients). General data, liver function indices, complications, adverse effects, and 3-year survival rates after different surgical treatments were recorded for the two groups. RESULTS There were no significant differences in baseline information (sex, age, tumor type, or tumor diameter) between the two groups (P > 0.05). Alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels were significantly better in both groups after surgery than before surgery (P < 0.05). The overall incidence of biliary bleeding, gastrointestinal bleeding, pancreatitis, and cholangitis was 6.9% in the observation group and 30% in the control group (P < 0.05). No significant differences in the rates of blood transfusion, intensive care unit admission, or death within 3 years were observed between the two groups at the 1-month follow-up (P > 0.05). The 3-year survival rates were 46.06% and 39.71% in the observation and control groups, respectively. CONCLUSION Endoscopic biliary stenting effectively relieves MOJ and significantly improves liver function, with minimal complications. This technique is a promising palliative approach for patients ineligible for radical surgery. However, further research is needed to optimize current treatment strategies and to explore their potential in treating nonmalignant cases of obstructive jaundice.
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Affiliation(s)
- Wei Wang
- Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan 430000, Hubei Province, China
| | - Chao Zhang
- Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan 430000, Hubei Province, China
| | - Bing Li
- Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan 430000, Hubei Province, China
| | - Ge-Yi-Lang Yuan
- Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan 430000, Hubei Province, China
| | - Zhi-Wu Zeng
- Department of General Surgery, Shenzhen University General Hospital, Shenzhen 518000, Guangdong Province, China
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Lee O, Yoon SJ, Jeong HJ, Lim SY, Chae H, Kim H, Han IW, Heo JS, Shin SH. Timing for a surgically safe and oncologically prompt pancreatoduodenectomy after preoperative biliary drainage in patients with bile duct cancer. ANZ J Surg 2025. [PMID: 39835628 DOI: 10.1111/ans.19392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 11/20/2024] [Accepted: 12/31/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Preoperative biliary drainage (PBD) is commonly performed in patients with bile duct cancer (BDC). However, data regarding the timing of pancreatoduodenectomy (PD) after PBD are insufficient. This study aimed to investigate the optimal timing for surgically and oncologically safe PD after PBD. METHODS Data of patients who underwent PD for BDC between 2018 and 2020 were reviewed. Risk factor analysis was performed to determine clinical associations of PBD with surgical and survival outcomes. Dose-response curves were plotted to indicate the effect of the time interval between PBD and PD on each outcome. RESULTS A total of 109 patients underwent PBD before surgery. In multivariable analysis, PD after 20 days of PBD was significantly associated with improved survival after adjusting for other risk factors (hazard ratio 0.119, 95% confidence interval 0.028-0.5000; P = 0.004). Dose-response graphs showed that rates of postoperative complications and survival were lower when PD was performed around 20 days after PBD. CONCLUSION In BDC patients, the rate of postoperative complications was lower with fair survival outcomes when PD was performed around 20 days after PBD. A large-scale, prospective study is needed to investigate surgical and oncological effects of PBD in BDC patients.
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Affiliation(s)
- Okjoo Lee
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Hye Jeong Jeong
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Soo Yeun Lim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Hochang Chae
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
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Maatouk M, Kbir GH, Ben Dhaou A, Nouira M, Chamekh A, Daldoul S, Sayari S, Ben Moussa M. Pancreatic surgery after preoperative biliary drainage in periampullary cancers: does timing matter? A systematic review and meta-analysis. HPB (Oxford) 2025; 27:10-20. [PMID: 39500706 DOI: 10.1016/j.hpb.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 09/14/2024] [Accepted: 10/08/2024] [Indexed: 01/06/2025]
Abstract
BACKGROUND Preoperative biliary drainage (PBD) has been introduced to control the negative effects of obstructive jaundice in patients undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD remains unclear. The purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD before PD. METHODS Studies were searched in PubMed, Science Direct, Google Scholar and Cochrane Library until 30 March 2024. Studies using PBD in patients with malignant obstructive jaundice that compared the short duration group (SDG) with prolonged duration group (PDG) were included in this study. The definitions of short and prolonged drainage were based on cut-off times reported in the included studies. RESULTS Twelve studies were included. Based on the available data, short and prolonged drainage periods were defined by comparing the outcomes of surgeries performed within specific cut-off times of 2 weeks, 3 weeks, and 4 weeks after PBD. No significant differences were observed between the SDG and PDG in mortality, major morbidity, pancreatic fistula, post pancreatectomy haemorrhage, septic complications, operative time, and hospital stay, regardless of the delay of surgery. CONCLUSION When PBD is needed, pancreatic resection could be performed at the earliest possible stage after achieving optimal perioperative care.
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Affiliation(s)
- Mohamed Maatouk
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Ghassen H Kbir
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Anis Ben Dhaou
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mariem Nouira
- Service of Medical Epidemiology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Atef Chamekh
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sami Daldoul
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sofien Sayari
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mounir Ben Moussa
- A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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11
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Impellizzeri G, Grassini MV, Donato G, De Angelis CG, Pagano N. An Approach to and Treatment of Indeterminate Biliary Strictures: A Comprehensive Review of the Literature. J Clin Med 2024; 14:29. [PMID: 39797112 PMCID: PMC11721181 DOI: 10.3390/jcm14010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 12/02/2024] [Accepted: 12/18/2024] [Indexed: 01/13/2025] Open
Abstract
This review aims to focus on what we know about the management of biliary strictures of unknown etiology, especially exploring our diagnostic armamentarium in the setting of indeterminate biliary strictures. Presently, this is a current issue that has a relevant impact both on patient prognosis, often delaying diagnosis, and on overall costs associated with repeating diagnostic procedures, sometimes performed with very expensive devices. We also focus on current biliary drainage approaches, providing an overview of therapeutic options, endoscopic or not.
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Affiliation(s)
- Giovanna Impellizzeri
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (G.I.); (C.G.D.A.)
| | - Maria Vittoria Grassini
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy;
| | - Giulio Donato
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (G.I.); (C.G.D.A.)
| | - Claudio Giovanni De Angelis
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (G.I.); (C.G.D.A.)
| | - Nico Pagano
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (G.I.); (C.G.D.A.)
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12
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Marzioni M, Crinò SF, Lisotti A, Fuccio L, Vanella G, Amato A, Bertani H, Binda C, Coluccio C, Forti E, Fugazza A, Ligresti D, Maida M, Marchegiani G, Mauro A, Mirante VG, Ricci C, Rizzo GEM, Scimeca D, Spadaccini M, Arvanitakis M, Anderloni A, Fabbri C, Tarantino I, Arcidiacono PG. Biliary drainage in patients with malignant distal biliary obstruction: results of an Italian consensus conference. Surg Endosc 2024; 38:6207-6226. [PMID: 39317905 PMCID: PMC11525304 DOI: 10.1007/s00464-024-11245-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/30/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular. METHODS The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process. RESULTS AND CONCLUSIONS The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO.
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Affiliation(s)
- Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134, Verona, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna - Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
| | - Arnaldo Amato
- Department of Digestive Endoscopy and Gastroenterology ASST, Lecco, Italy
| | - Helga Bertani
- Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
| | - Marcello Maida
- Gastroenterology Unit, Umberto I Hospital - Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy
| | - Giovanni Marchegiani
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Vincenzo Giorgio Mirante
- Gastroenterologia ed Endoscopia Digestiva, Dipartimento Oncologico e Tecnologie Avanzate, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Ricci
- Department of Medical and Surgical Sciences, University of Bologna - Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, 90127, Palermo, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
| | - Marianna Arvanitakis
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134, Verona, Italy
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
- Department of Medical and Surgical Sciences, University of Bologna - Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
- Department of Digestive Endoscopy and Gastroenterology ASST, Lecco, Italy
- Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
- Gastroenterology Unit, Umberto I Hospital - Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
- Gastroenterologia ed Endoscopia Digestiva, Dipartimento Oncologico e Tecnologie Avanzate, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Bologna - Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, 90127, Palermo, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
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13
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Longo F, Panza E, Rocca L, Biffoni B, Lucinato C, Cintoni M, Mele MC, Papa V, Fiorillo C, Quero G, De Sio D, Menghi R, Alfieri S, Langellotti L. Enhanced Recovery After Surgery (ERAS) in Pancreatic Surgery: The Surgeon's Point of View. J Clin Med 2024; 13:6205. [PMID: 39458155 PMCID: PMC11508928 DOI: 10.3390/jcm13206205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 10/08/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
Pancreatic surgery is complex and associated with higher rates of morbidity and mortality compared to other abdominal surgeries. Over the past decade, the introduction of new technologies, such as minimally invasive approaches, improvements in multimodal treatments, advancements in anesthesia and perioperative care, and better management of complications, have collectively improved patient outcomes after pancreatic surgery. In particular, the adoption of Enhanced Recovery After Surgery (ERAS) recommendations has reduced hospital stays and improved recovery times, as well as post-operative outcomes. The aim of this narrative review is to highlight the surgeon's perspective on the ERAS program for pancreatic surgery, with a focus on its potential advantages for perioperative functional recovery outcomes.
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Affiliation(s)
- Fabio Longo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Edoardo Panza
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Lorenzo Rocca
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Beatrice Biffoni
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Chiara Lucinato
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Marco Cintoni
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valerio Papa
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Davide De Sio
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Roberta Menghi
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Lodovica Langellotti
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
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Wang X, Bai Y, Chai N, Li Y, Linghu E, Wang L, Liu Y, Society of Hepato-pancreato-biliary Surgery of Chinese Research Hospital Association, Society of Digestive Endoscopy of the Chinese Medical Association, Chinese Medical Journal Clinical Practice Guideline Collaborative. Chinese national clinical practice guideline on diagnosis and treatment of biliary tract cancers. Chin Med J (Engl) 2024; 137:2272-2293. [PMID: 39238075 PMCID: PMC11441919 DOI: 10.1097/cm9.0000000000003258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Biliary tract carcinoma (BTC) is relatively rare and comprises a spectrum of invasive tumors arising from the biliary tree. The prognosis is extremely poor. The incidence of BTC is relatively high in Asian countries, and a high number of cases are diagnosed annually in China owing to the large population. Therefore, it is necessary to clarify the epidemiology and high-risk factors for BTC in China. The signs associated with BTC are complex, often require collaborative treatment from surgeons, endoscopists, oncologists, and radiation therapists. Thus, it is necessary to develop a comprehensive Chinese guideline for BTC. METHODS This clinical practice guideline (CPG) was developed following the process recommended by the World Health Organization. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of evidence and make recommendations. The full CPG report was reviewed by external guideline methodologists and clinicians with no direct involvement in the development of this CPG. Two guideline reporting checklists have been adhered to: Appraisal of Guidelines for Research and Evaluation (AGREE) and Reporting Items for practice Guidelines in Healthcare (RIGHT). RESULTS The guideline development group, which comprised 85 multidisciplinary clinical experts across China. After a controversies conference, 17 clinical questions concerning the prevention, diagnosis, and treatment of BTC were proposed. Additionally, detailed descriptions of the surgical principles, perioperative management, chemotherapy, immunotherapy, targeted therapy, radiotherapy, and endoscopic management were proposed. CONCLUSIONS The guideline development group created a comprehensive Chinese guideline for the diagnosis and treatment of BTC, covering various aspects of epidemiology, diagnosis, and treatment. The 17 clinical questions have important reference value for the management of BTC.
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Affiliation(s)
- Xu’an Wang
- Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Systems Medicine for Cancers, Shanghai Cancer Institute; Shanghai Key Laboratory for Cancer Systems Regulation and Clinical Translation, Shanghai 200127, China
| | - Yongrui Bai
- Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ningli Chai
- Department of Gastroenterology and Hepatology, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yexiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Liwei Wang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute; Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yingbin Liu
- Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Systems Medicine for Cancers, Shanghai Cancer Institute; Shanghai Key Laboratory for Cancer Systems Regulation and Clinical Translation, Shanghai 200127, China
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15
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Camps-Lasa J, García-Domingo MI, Herrero Fonollosa E, Galaviz Sosa ML, Galofré Recasens M, Rodríguez Campos A, Serra-Aracil X, Cugat Andorrá E. Need for a targeted perioperative antibiotic treatment protocol for patients with preoperative biliary drainage undergoing pancreaticoduodenectomy. Cir Esp 2024; 102:540-547. [PMID: 39304127 DOI: 10.1016/j.cireng.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 09/01/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE To evaluate the bacterobilia in patients undergoing pancreaticoduodenectomy (PD) based on whether they carry a preoperative biliary drainage or not and to analyse if a targeted perioperative antibiotic treatment based on the expected microbiology leads in no differences in Surgical Site Infections (SSI) between the groups. METHODS Retrospective observational single-center study of patients undergoing pancreaticoduodenectomy with preoperative biliary stent (group P, Prosthesis) and without stent (group NP, No Prosthesis). Postoperative complications including SSI and its subtypes were analyzed after applying a targeted perioperative antibiotic treatment protocol with cefotaxime and metronidazole (group NP) and piperacillin-tazobactam (group P). RESULTS Between January 2014 and December 2021, 127 patients were treated (84 in group NP and 43 in group P). Intraoperative cultures were positive in 16.7% (group NP) vs 76.7% (group P, p < 0.01). Microorganisms isolated in group NP included Enterobacterales (10.7%) and Enterococcus spp. (7.1%) with no Candida detected. In group P: Enterobacterales (51.2%), Enterococcus spp. (48.8%), and Candida (16.3%) were higher (p < 0.01%). No differences in morbidity and mortality were observed between the groups. SSI rate was 17.8% in group NP and 23.2% in group P (ns). CONCLUSION Bacterobilia differs in patients with biliary drainage, showing a higher presence of Enterobacterales, Enterococcus spp., and Candida. There were no differences in SSI incidence after applying perioperative antibiotic treatment tailored to the expected microorganisms in each group. This raises the need to reconsider conventional surgical prophylaxis in patients with biliary stent.
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Affiliation(s)
- Judith Camps-Lasa
- Cirugía General y del Aparato Digestivo, Unidad HBP, Hospital Universitari Mutua Terrassa, Universitat de Barcelona (UB), Terrassa, Barcelona, Spain
| | - María Isabel García-Domingo
- Cirugía General y del Aparato Digestivo, Unidad HBP, Hospital Universitari Mutua Terrassa, Universitat de Barcelona (UB), Terrassa, Barcelona, Spain.
| | - Eric Herrero Fonollosa
- Cirugía General y del Aparato Digestivo, Unidad HBP, Hospital Universitari Mutua Terrassa, Universitat de Barcelona (UB), Terrassa, Barcelona, Spain
| | - María Luisa Galaviz Sosa
- Cirugía General y del Aparato Digestivo, Unidad HBP, Hospital Universitari Mutua Terrassa, Universitat de Barcelona (UB), Terrassa, Barcelona, Spain
| | - María Galofré Recasens
- Cirugía General y del Aparato Digestivo, Unidad HBP, Hospital Universitari Mutua Terrassa, Universitat de Barcelona (UB), Terrassa, Barcelona, Spain
| | - Aurora Rodríguez Campos
- Servicio de Anestesiología, Hospital Universitari Mutua Terrassa, Universitat de Barcelona (UB), Terrassa, Barcelona, Spain
| | - Xavier Serra-Aracil
- Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - Esteban Cugat Andorrá
- Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Barcelona, Spain
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Rizqiansyah CY, Awatara PID, Amar N, Lesmana CRA, Mustika S. Efficacy and safety of endoscopic ultrasonography (EUS) hepaticogastrostomy (HGS) versus choledochoduodenostomy (CDS) in ERCP-failed malignant biliary obstruction: A systematic review and META-analysis. JGH Open 2024; 8:e70037. [PMID: 39439478 PMCID: PMC11494398 DOI: 10.1002/jgh3.70037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/25/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in managing malignant biliary obstruction. The success of ERCP has limitations, whereas surgical biliary bypass and percutaneous transhepatic approaches, as alternative modalities, come with significant costs, longer durations, and higher levels of mortality and morbidity. Endoscopic ultrasonography (EUS)-guided biliary drainage with two approaches, hepaticogastrostomy (EUS-HGS) and choledochoduodenostomy (EUS-CDS), is a favored and evolving alternative modality. This study aims to compare the efficacy and safety of EUS-HGS and EUS-CDS. We conducted a systematic review and meta-analysis by searching PubMed, ScienceDirect, Cochrane Library, and Scholar databases up to August 2023, based on the 2020 PRISMA guidelines. We identified randomized and nonrandomized studies comparing the efficacy and safety of EUS-HGS and EUS-CDS. Outcome measures included technical and clinical success, side effects, and mean procedure time. Nine nonrandomized studies and two randomized controlled trials involving 537 patients (225 EUS-HGS, 312 EUS-CDS) were analyzed. No difference was found in technical success (OR, 0.83; 95% CI, 0.41-1.68; I 2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51-1.81; I 2 = 9.94%). Side effects were significantly higher in EUS-HGS (OR, 2.01, 95% CI, 1.14-3.59; I 2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, -0.15-0.41; I 2 = 34.89%). There are differences in efficacy and safety between EUS-HGS and EUS-CDS. EUS-CDS has a faster procedure time, lower risk of side effects, and ease of puncture during the procedure.
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Affiliation(s)
- Chrisandi Y Rizqiansyah
- Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
| | | | - Nasim Amar
- Faculty of Medicine Universitas BrawijayaMalangIndonesia
| | - Cosmas R A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | - Syifa Mustika
- Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
- Gastroenterohepatology Division, Internal Medicine DepartmentFaculty of Medicine Universitas Brawijaya, Saiful Anwar General HospitalMalangIndonesia
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17
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Yu ZH, Du MM, Zhang X, Suo JJ, Zeng T, Xie XL, Xiao W, Lu QB, Liu YX, Yao HW. The impact of preoperative biliary drainage on postoperative healthcare-associated infections and clinical outcomes following pancreaticoduodenectomy: a ten-year retrospective analysis. BMC Infect Dis 2024; 24:361. [PMID: 38549089 PMCID: PMC10979617 DOI: 10.1186/s12879-024-09246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/22/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a complex procedure and easily accompanied by healthcare-associated infections (HAIs). This study aimed to assess the impact of PBD on postoperative infections and clinical outcomes in PD patients. METHODS The retrospective cohort study were conducted in a tertiary hospital from January 2013 to December 2022. Clinical and epidemiological data were collected from HAIs surveillance system and analyzed. RESULTS Among 2842 patients who underwent PD, 247 (8.7%) were diagnosed with HAIs, with surgical site infection being the most frequent type (n = 177, 71.7%). A total of 369 pathogenic strains were detected, with Klebsiella pneumoniae having the highest proportion, followed by Enterococcu and Escherichia coli. Although no significant association were observed generally between PBD and postoperative HAIs, subgroup analysis revealed that PBD was associated with postoperative HAIs in patients undergoing robotic PD (aRR = 2.174; 95% CI:1.011-4.674; P = 0.047). Prolonging the interval between PBD and PD could reduce postoperative HAIs in patients with cholangiocarcinoma (≥4 week: aRR = 0.292, 95% CI 0.100-0.853; P = 0.024) and robotic PD (≤2 week: aRR = 3.058, 95% CI 1.178-7.940; P = 0.022). PBD was also found to increase transfer of patients to ICU (aRR = 1.351; 95% CI 1.119-1.632; P = 0.002), extended length of stay (P < 0.001) and postoperative length of stay (P = 0.004). CONCLUSION PBD does not exhibit a significant association with postoperative HAIs or other outcomes. However, the implementation of robotic PD, along with a suitable extension of the interval between PBD and PD, appear to confer advantages concerning patients' physiological recuperation. These observations suggest potential strategies that may contribute to enhanced patient outcomes.
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Affiliation(s)
- Zheng-Hao Yu
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, 28 Fu-Xing Road, Haidian District, Beijing, 100853, P. R. China
- Medical School of Chinese PLA, Beijing, P. R. China
| | - Ming-Mei Du
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, 28 Fu-Xing Road, Haidian District, Beijing, 100853, P. R. China
| | - Xuan Zhang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, P. R. China
- Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, P. R. China
| | - Ji-Jiang Suo
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, 28 Fu-Xing Road, Haidian District, Beijing, 100853, P. R. China
| | - Tao Zeng
- Medical School of Chinese PLA, Beijing, P. R. China
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, P. R. China
| | - Xiao-Lian Xie
- Department of Central Sterile Supply, Ningxia People's Armed Police Corps Hospital, Yinchuan, P. R. China
| | - Wei Xiao
- Department Of Hospital Infection-Control, Lanzhou University Second Hospital, Gansu, P. R. China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, 38 Xue-Yuan Road, Haidian District, Beijing, 100191, P. R. China.
| | - Yun-Xi Liu
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, 28 Fu-Xing Road, Haidian District, Beijing, 100853, P. R. China.
| | - Hong-Wu Yao
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, 28 Fu-Xing Road, Haidian District, Beijing, 100853, P. R. China.
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18
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Yoshimi Y, Noji T, Okamura K, Tanaka K, Matsui A, Nakanishi Y, Asano T, Nakamura T, Tsuchikawa T, Kawamoto Y, Harada K, Fuyama K, Okada K, Hirano S. The Short- and Long-Term Surgical Results of Consecutive Hepatopancreaticoduodenectomy for Wide-Spread Biliary Malignancy. Ann Surg Oncol 2024; 31:90-96. [PMID: 37899414 DOI: 10.1245/s10434-023-14406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/17/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Cancer-free resection (R0) is one of the most important factors for the long-term survival of biliary carcinoma. For some patients with widespread invasive cancer located between the hilar and intrapancreatic bile duct, hepatopancreaticoduodenectomy (HPD) is considered a radical surgery for R0 resection. However, HPD is associated with high morbidity and mortality rates. Furthermore, previous reports have not shown lymph node metastasis (LNM) status, such as the location or number, which could influence the prognosis after HPD. In this study, first, we explored the prognostic factors for survival, and second, we evaluated whether the LNM status (number and location of LNM) would influence the decision on surgical indications in patients with widely spread biliary malignancy. METHODS We retrospectively reviewed the medical records of 54 patients who underwent HPD with hepatectomy in ≥2 liver sectors from January 2003 to December 2021 (HPD-G). We also evaluated 54 unresectable perihilar cholangiocarcinoma patients who underwent chemotherapy from January 2010 to December 2021 (CTx-G). RESULTS R0 resection was performed in 48 patients (89%). The median survival time (MST) and 5-year overall survival rate of the HPD-G and CTx-G groups were 36.9 months and 31.1%, and 19.6 months and 0%, respectively. Univariate and multivariate analyses showed that pathological portal vein involvement was an independent prognostic factor for survival (MST: 18.9 months). Additionally, patients with peripancreatic LNM had worse prognoses (MST: 13.3 months) than CTx-G. CONCLUSIONS Patients with peripancreatic LNM or PV invasion might be advised to be excluded from surgery-first indications for HPD.
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Affiliation(s)
- Yasunori Yoshimi
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Aya Matsui
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Kawamoto
- Department of Gastroenterology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuaki Harada
- Department of Gastroenterology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanako Fuyama
- Department of Biostatistics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuhumi Okada
- Department of Biostatistics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Huang LM, Zeng ZX, Wu JY, Li YN, Wang JX, Fu YK, Wu JY, Wei SM, Lv JH, Chen WZ, Huang RF, Cheng SQ, Yan ML. Surgical outcomes of hepatocellular carcinoma with extrahepatic bile duct tumor thrombus: a multicenter study. Front Oncol 2023; 13:1291479. [PMID: 38111530 PMCID: PMC10726108 DOI: 10.3389/fonc.2023.1291479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Background The long-term prognosis after surgery of patients with hepatocellular carcinoma (HCC) and extrahepatic bile duct tumor thrombus (Ex-BDTT) remains unknown. We aimed to identify the surgical outcomes of patients with HCC and Ex-BDTT. Methods A total of 138 patients with Ex-BDTT who underwent hepatectomy with preservation of the extrahepatic bile duct from five large hospitals in China between January 2009 and December 2017 were included. The Cox proportional hazards model was used to analyze overall survival (OS) and recurrence-free survival (RFS). Results With a median follow-up of 60 months (range, 1-127.8 months), the median OS and RFS of the patients were 28.6 and 8.9 months, respectively. The 1-, 3-, and 5-year OS rates of HCC patients with Ex-BDTT were 71.7%, 41.2%, and 33.5%, respectively, and the corresponding RFS rates were 43.5%, 21.7%, and 20.0%, respectively. Multivariate analysis identified that major hepatectomy, R0 resection, and major vascular invasion were independent prognostic factors for OS and RFS. In addition, preoperative serum total bilirubin ≥ 4.2 mg/dL was an independent prognostic factor for RFS. Conclusion Major hepatectomy with preservation of the extrahepatic bile duct can provide favorable long-term survival for HCC patients with Ex-BDTT.
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Affiliation(s)
- Li-Ming Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhen-Xin Zeng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun-Yi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yi-Nan Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jin-Xiu Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Yang-Kai Fu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jia-Yi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Shao-Ming Wei
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China
| | - Jia-Hui Lv
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei-Zhao Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Rong-Fa Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Mao-Lin Yan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
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20
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Chai J, Liu K, Xu B, Wang L, Yu H, Lv W, Lu D. Biliary self-expandable metallic stent combined with iodine-125 seeds in the treatment of malignant biliary obstruction (Bismuth type I or II). Surg Endosc 2023; 37:7729-7737. [PMID: 37566117 DOI: 10.1007/s00464-023-10327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The purpose of this research was to evaluate the safety and efficacy of a self-expandable metallic stent (SEMS) combined with iodine-125 (125I) seeds in the treatment of Bismuth type I or II malignant biliary obstruction (MBO). METHODS The clinical data of 74 cases of MBO treated with percutaneous SEMS combined with 125I seeds (combination group) and 81 cases of MBO treated with SEMS implantation alone (control group) in our hospital from January 2015 to December 2019 were retrospectively analyzed. The short-term and long-term efficacy of the two groups were compared. Multivariate Cox regression analysis was used to analyze the factors affecting the surgical efficacy and survival rate. RESULTS The liver blood test results of both groups improved at one week and one month post-stent insertion. No significant difference was established in the short-term efficacy or complications between the two groups (P = NS). Improved stent patency was observed in the combined group, 9.01 ± 4.38 months versus 6.79 ± 3.13 months, respectively (P < 0.001). Improved survival was also noted in the combined group 12.08 ± 5.38 months and 9.10 ± 4.16 months, respectively (P < 0.001). Univariate and multivariate analyses showed that the type of biliary stent and liver metastasis were independent factors affecting survival. CONCLUSION The implementation of SEMS combined with 125I seeds resulted in significantly longer stent patency and survival times than that of SEMS implantation alone, which is thus worthy of clinical promotion and application.
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Affiliation(s)
- Jie Chai
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Kaicai Liu
- Infection Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230022, Anhui, China
| | - Beibei Xu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Lijun Wang
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Huafeng Yu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Weifu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230001, Anhui, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230001, Anhui, China.
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21
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Kandurova KY, Sumin DS, Mamoshin AV, Potapova EV. Deconvolution of the fluorescence spectra measured through a needle probe to assess the functional state of the liver. Lasers Surg Med 2023; 55:690-701. [PMID: 37300892 DOI: 10.1002/lsm.23695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Currently, one of the most pressing issues for surgeons in the treatment of obstructive jaundice is the ability to assess the functional state of the liver and to detect and determine the degree of liver failure in a timely manner with simple and objective techniques. In this regard, the use of fluorescence spectroscopy method can be considered as one of the ways to improve the informativity of existing diagnostic algorithms in clinical practice and to introduce new diagnostic tools. Thus, the aim of the work was to study in vivo the functional state of liver parenchyma by the method of fluorescence spectroscopy implemented through a needle probe and assess the contribution of the main tissue fluorophores to reveal new diagnostic criteria. MATERIALS AND METHODS We compared data from 20 patients diagnosed with obstructive jaundice and 11 patients without this syndrome. Measurements were performed using a fluorescence spectroscopy method at excitation wavelengths of 365 and 450 nm. Data were collected using a 1 mm fiber optic needle probe. The analysis was based on the comparison of the results of deconvolution with the combinations of Gaussian curves reflecting the contribution of the pure fluorophores in the liver tissues. RESULTS The results showed a statistically significant increase in the contribution of curves reflecting NAD(P)H fluorescence, bilirubin, and flavins in the group of patients with obstructive jaundice. This and the calculated redox ratio values indicated that the energy metabolism of the hepatocytes may have shifted to glycolysis due to hypoxia. An increase in vitamin A fluorescence was also observed. It may also serve as a marker of liver damage, indicating impaired vitamin A mobilization from the liver due to cholestasis. CONCLUSIONS The results obtained reflect changes associated with shifts in the content of the main fluorophores characterizing hepatocyte dysfunction caused by accumulation of bilirubin and bile acids and after disturbance of oxygen utilization. The contributions of NAD(P)H, flavins, and bilirubin as well as vitamin A can be used for further studies as promising diagnostic and prognostic markers for the course of liver failure. Further work will include collecting fluorescence spectroscopy data in patients with different clinical effects of obstructive jaundice on postoperative clinical outcome after biliary decompression.
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Affiliation(s)
- Ksenia Y Kandurova
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Dmitry S Sumin
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Department of Interventional Radiology, Orel Regional Clinical Hospital, Orel, Russia
| | - Andrian V Mamoshin
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Department of Interventional Radiology, Orel Regional Clinical Hospital, Orel, Russia
| | - Elena V Potapova
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
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22
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Liu JJ, Sun YM, Xu Y, Mei HW, Guo W, Li ZL. Pathophysiological consequences and treatment strategy of obstructive jaundice. World J Gastrointest Surg 2023; 15:1262-1276. [PMID: 37555128 PMCID: PMC10405123 DOI: 10.4240/wjgs.v15.i7.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/29/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.
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Affiliation(s)
- Jun-Jian Liu
- Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, Tianjin 300102, China
| | - Yi-Meng Sun
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Yan Xu
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Han-Wei Mei
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Wu Guo
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Zhong-Lian Li
- Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, Tianjin 300102, China
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23
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Medas R, Ferreira-Silva J, Girotra M, Barakat M, Tabibian JH, Rodrigues-Pinto E. Best Practices in Pancreatico-biliary Stenting and EUS-guided Drainage. J Clin Gastroenterol 2023; 57:553-568. [PMID: 36040964 DOI: 10.1097/mcg.0000000000001760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Indications for endoscopic placement of endoluminal and transluminal stents have greatly expanded over time. Endoscopic stent placement is now a well-established approach for the treatment of benign and malignant biliary and pancreatic diseases (ie, obstructive jaundice, intra-abdominal fluid collections, chronic pancreatitis etc.). Ongoing refinement of technical approaches and development of novel stents is increasing the applicability and success of pancreatico-biliary stenting. In this review, we discuss the important developments in the field of pancreatico-biliary stenting, with a specific focus on endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-associated developments.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joel Ferreira-Silva
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mohit Girotra
- Digestive Health Institute, Swedish Medical Center, Seattle, WA
| | | | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar
- UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA CA
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Tang BX, Li XL, Wei N, Tao T. Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report. World J Gastrointest Surg 2023; 15:1211-1215. [PMID: 37405085 PMCID: PMC10315106 DOI: 10.4240/wjgs.v15.i6.1211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography (ERCP) procedure. We report a case of percutaneous transhepatic cholangial drainage (PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.
CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice, and ERCP procedure need to be performed to treat the obstructive jaundice. But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum. We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy, and bile duct intubation was successfully completed.
CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
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Affiliation(s)
- Bing-Xi Tang
- Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Xin-Li Li
- Laboratory Section, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Ning Wei
- Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China
| | - Tao Tao
- Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China
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25
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Sato K, Shigekawa M, Kozumi K, Okabe J, Sato Y, Tamura T, Yoshioka T, Sakamori R, Iwagami Y, Yamada D, Tomimaru Y, Noda T, Takahashi H, Kobayashi S, Eguchi H, Tatsumi T, Takehara T. Initial drainage‐related prognostic factors for perihilar cholangiocarcinoma: A single‐center retrospective study. DEN OPEN 2023; 3:e127. [PMID: 35898846 PMCID: PMC9307739 DOI: 10.1002/deo2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 12/07/2022]
Abstract
Objectives Perihilar cholangiocarcinoma (PCC) is a complex disorder involving the hepatic hilum. Multiple endoscopic retrograde cholangiopancreatography sessions are necessary for diagnosis and treatment with underlying cholangitis risk. Our aim is to clarify the initial‐drainage‐related prognostic factors of PCC. Methods This study was a single‐center retrospective study. A total of 104 consecutive patients diagnosed with PCC from January 2010 to February 2020 were enrolled. We defined the diagnostic period as the time between the first biliary drainage attempt and the final drainage when treatment, including surgery or chemotherapy, was started. We focused on this initial period and analyzed the endoscopy‐related factors that affected mortality. Results Overall survival of all PCC patients was 599 days. Overall survival of surgically treated patients and unresectable patients were 893 days and 512 days, respectively. In 48 surgically treated patients, drainage‐related cholangitis within the diagnostic period, defined as new cholangitis that occurred after the first biliary drainage attempt, worsened overall survival from 1460 days to 607 days. Endoscopic sphincterotomy, the first drainage method other than endoscopic nasobiliary drainage, and four or more endoscopic retrograde cholangiopancreatography sessions were risk factors for drainage‐related cholangitis. Drainage‐related cholangitis increased pathological lymph node metastasis. Percutaneous transhepatic biliary drainage as final drainage was the only prognostic factor in unresectable chemotherapy‐treated patients. Conclusions Drainage‐related cholangitis worsened the prognosis in PCC patients who underwent surgery. Appropriate endoscopic retrograde cholangiopancreatography strategies, especially during the diagnostic period, are of great importance in PCC.
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Affiliation(s)
- Katsuhiko Sato
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Minoru Shigekawa
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Kazuhiro Kozumi
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Junya Okabe
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Yu Sato
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Takeshi Tamura
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Teppei Yoshioka
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Ryotaro Sakamori
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Tomohide Tatsumi
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan
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Dondorf F, Rohland O, Deeb AA, Ardelt M, Settmacher U, Rauchfuss F. Value of palliative surgery in perihilar cholangiocarcinoma. Langenbecks Arch Surg 2023; 408:128. [PMID: 36977835 PMCID: PMC10049926 DOI: 10.1007/s00423-023-02854-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE The survival rate of patients with irresectable perihilar cholangiocarcinoma is remarkably poor. An essential part of palliation is treatment of obstructive cholestasis caused by the tumor. Currently, this is mainly performed endoscopically by stent or via PTBD, requiring frequent changes of the stents and limiting health-related quality of life due to the multiple hospital stays needed. The aim of this study was to evaluate surgical palliation via extrahepatic bile duct resection as an option for palliative treatment. METHODS Between 2005 and 2016, we treated 120 pCCC patients with primary palliative care. Three treatment strategies were retrospectively considered: extrahepatic bile duct resection (EBR), exploratory laparotomy (EL), and primary palliative (PP) therapy. RESULTS The EBR group required significantly less stenting postoperatively, and the overall morbidity was 29.4% (EBR). After the surgical procedure, fewer subsequent endoscopic treatments for stenting or PTBD were necessary in the EBR group over time. The 30-day mortality was 5.9% (EBR) and 3.4% (EL). The median overall survival averaged 570 (EBR), 392 (EL), and 247 (PP) days. CONCLUSIONS In selected pCCC patients, palliative extrahepatic bile duct resection is a feasible option for treatment of obstructive cholestasis and should be reconsidered as a therapy option for these patients even in a palliative setting.
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Affiliation(s)
- Felix Dondorf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Oliver Rohland
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Aladdin Ali Deeb
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Falk Rauchfuss
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Amaral MJ, Freitas J, Amaral M, Serôdio M, Oliveira RC, Donato P, Tralhão JG. Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head. Diagnostics (Basel) 2023; 13:diagnostics13071281. [PMID: 37046501 PMCID: PMC10093239 DOI: 10.3390/diagnostics13071281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (p = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, p < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, p = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, p = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, p = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence.
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Affiliation(s)
- Maria João Amaral
- General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Correspondence:
| | - João Freitas
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Mariana Amaral
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Marco Serôdio
- General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Rui Caetano Oliveira
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Paulo Donato
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - José Guilherme Tralhão
- General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Biophysics Institute, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
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Chen Y, Zhang C, Luo T. Percutaneous transhepatic cholangial drainage/percutaneous transhepatic biliary stent implantation for treatment of extrahepatic cholangiocarcinoma with obstructive jaundice. Shijie Huaren Xiaohua Zazhi 2023; 31:165-171. [DOI: 10.11569/wcjd.v31.i5.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Extrahepatic cholangiocarcinoma is a malignant tumor originating from the extrahepatic bile duct including the hilar region to the lower bile duct of the common bile duct. With the development of interventional techniques and medical materials, percutaneous transhepatic cholangial drainage (PTCD) or percutaneous transhepatic biliary stent implantation (PTBS) has become the main treatment to relieve biliary obstruction. However, the occurrence of postoperative complications seriously affects the prognosis of patients, and the combination of biliary stenting with local treatment has been found to significantly prolong the time to biliary patency. This article reviews the progress of PTCD/PTBS in the treatment of extrahepatic cholangiocarcinoma with obstructive jaundice, evaluates its clinical efficacy, and points out the current problems and posible solutions to provide more reference for subsequent related studies.
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Affiliation(s)
- Yue Chen
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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29
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Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg 2023; 47:11-34. [PMID: 36310325 PMCID: PMC9726826 DOI: 10.1007/s00268-022-06732-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. METHODS A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. RESULTS A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. CONCLUSIONS These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
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Scherber PR, Gäbelein G, Spiliotis AE, Igna D, Holländer S, Jacob P, Hofmann J, Glanemann M. Role of biliary drainage before pancreatoduodenectomy for pancreatic adenocarcinoma: a retrospective study. Minerva Surg 2022; 77:550-557. [PMID: 35230040 DOI: 10.23736/s2724-5691.22.09414-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Utilization of preoperative biliary drainage prior to pancreatoduodenectomy for patients with pancreatic ductal adenocarcinoma and obstructive jaundice remains controversial. METHODS All patients that underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma at the authors' institution were analyzed retrospectively to evaluate the effect of endoscopic biliary drainage on postoperative outcomes and long-term survival. Age, gender, ASA-Score, operative time, blood loss, intraoperative transfusion rate, and postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, bleeding, bile fistula, wound infections, sepsis, pulmonary and cardiac complications as well as the need for relaparotomy were analyzed. RESULTS Two hundred eighty-five patients with similar baseline characteristics underwent pancreatoduodenectomy, 151 patients with biliary drainage (group 1) and 134 without drainage (group 2). More than 60% of patients had one or more postoperative complications, without significant difference between the two groups (P=0.140). The overall incidence of pancreatic fistula was 21.75% in both groups (group 1: 19.87% vs. group 2: 23.88%, P=0.659). Wound healing impairment was the only postoperative complication that differed significantly between the two groups (group 1: 24.50% vs. group 2: 8.96%, P<0.001). In multivariate risk analysis, biliary drainage was the only independent risk factor for wound healing impairment (OR 4.126; 95% CI: 1.295-13.143; P=0.017). The median overall survival was similar in both groups. CONCLUSIONS Preoperative endoscopic biliary drainage is associated with an increased risk for wound healing impairment and wound infections. Therefore, biliary drainage should not be used routinely in patients with obstructive jaundice prior to pancreatoduodenectomy.
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Affiliation(s)
- Philipp R Scherber
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Antonios E Spiliotis
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany -
| | - Dorian Igna
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Sebastian Holländer
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Peter Jacob
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Julia Hofmann
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
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Bineshfar N, Malekpour Alamdari N, Rostami T, Mirahmadi A, Zeinalpour A. The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study. BMC Surg 2022; 22:399. [DOI: 10.1186/s12893-022-01853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Biliary obstruction which is a major complication of pancreas and periampullary tumors could result in cholangitis, coagulopathies, gastrointestinal symptoms, and impaired wound healing. Pancreaticoduodenectomy (PD) is still the standard approach for pancreas resection and imposes high risk of morbidity and mortality to patients. To reduce the high risk of PD and address the biliary obstruction, the use of preoperative biliary stenting was increased. However, available literature doubts its efficiency.
Methods
A total of 147 patients who underwent PD between September 2012, and February 2022, at three medical centers were identified. Patients were grouped based on biliary stent placement. Non-jaundiced patients with and without preoperative biliary drainage (PBD) were compared.
Results
The incidence of overall complications (34.2% versus 45.8%) and mortality (17.8% versus 24.3%) did not differ in the PBD group compared to the no PBD group. There was no difference in complications and mortality in non-jaundiced patients with and without PBD. Patients with drainage duration of > 30 days experienced more overall complications compared to patients with less than 30 days drainage duration (12 (50.0%) and three (15.8%) patients, respectively, p-value = 0.019).
Conclusions
PBD does not significantly increase the post-operative burden on patients who undergo PD. However, we cannot overlook the financial burden that PBD places on the patient and the healthcare system, as well as the difficulties related to endoscopic retrograde cholangiopancreatography (ERCP). Therefore, biliary stenting should not be routinely practiced in the absence of a valid indication, such as severe jaundice, pruritus, cholangitis, delayed surgery for neoadjuvant treatment, or referral to a tertiary facility.
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Farooqu W, Penninga L, Burgdorf SK, Krohn PS, Storkholm JH, Hansen CP. Relieving the bile ducts prior to pancreatoduodenectomy – A retrospective cohort study. Ann Med Surg (Lond) 2022; 84:104894. [DOI: 10.1016/j.amsu.2022.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 11/14/2022] Open
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Aimagambetov MZ, Orazgalieva MT, Omarov NB, Zhanybekov SD, Orazalina AS. Blood Disorders in Patients with Obstructive Jaundice: A Literature Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Mechanical jaundice is a pathological syndrome consisting in a violation of the outflow of hepatic bile through the bile ducts into the duodenum due to mechanical obstacles. The most common causes of mechanical jaundice are gallstone disease, malignant tumors, as well as cicatricial stricture of the bile duct or the large duodenal papilla of the duodenum. All this leads to the development of renal-hepatic insufficiency. Thrombohemorrhagic changes develop in the vascular bed, leading to the development of disseminated intravascular coagulation syndrome. Prevention and treatment of cholemic bleeding in case of mechanical jaundice remains one of the complex problems of hepatobiliary surgery. This article is an overview of the causes and pathophysiological changes affecting hemostasis in mechanical jaundice, as well as the main points of treatment of hemostasis disorders in patients with mechanical jaundice.
AIM: This study aims to study the literature on homeostasis in patients with mechanical jaundice.
SEARCH STRATEGY: To conduct a systematic search for scientific information and to achieve this goal, an analysis of scientific publications in evidence-based medicine databases (PubMed), using specialized search engines (Google Scholar) and in electronic scientific libraries (CyberLeninka, e-library) was carried out from 2005 to 2020.
INCLUSION CRITERIA: Research of high methodological quality: Meta-analysis, systematic review and cohort studies, as well as publications with clearly formulated and statistically proven conclusions in English, Russian, and Kazakh.
EXCLUSION CRITERIA: Summaries of reports, reports in the form of abstracts, and advertising articles.
RESULTS: The mechanisms that affect hemostasis in obstructive jaundice can be considered from four perspectives: The first relates to Vitamin K deficiency in obstructive jaundice, the second describes the effect of ongoing fibrosis and cirrhosis of the liver on hemostasis, the third analyzes the relationship between infectious-septic mechanisms and the hemostasis system, their clinical significance in patients with obstructive jaundice, and the latter involves the analysis of specific factors that manifest obstructive jaundice and may themselves affect the blood coagulation system.
CONCLUSION: Understanding the pathophysiology of hemostatic changes in patients with cholestasis and, more generally, liver disease is a clear way to accurate diagnosis and treatment. The combination of good knowledge with careful examination of each patient can lead to the most promising result.
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Liu H, Shi C, Yan Z, Luo M. A single-center retrospective study comparing safety and efficacy of endoscopic biliary stenting only vs. EBS plus nasobiliary drain for obstructive jaundice. Front Med (Lausanne) 2022; 9:969225. [PMID: 36186815 PMCID: PMC9515354 DOI: 10.3389/fmed.2022.969225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeBiliary drainage is an important modality for extrahepatic obstructive jaundice both in patients with palliative and resectable. Currently, endoscopic biliary drainage is preferred in clinical practice, including endoscopic nasobiliary drainage (ENBD) and endoscopic biliary stenting (EBS), both of which have their own advantages and disadvantages. The purpose of our study was to compare the safety and efficacy of endoscopic biliary stenting (EBS) only vs. EBS plus nasobiliary drain for obstructive jaundice.MethodsWe consecutively reviewed patients with endoscopic biliary drainage in our institution from November 2014 to March 2021. Combined (ENBD plus stent) and single approach (EBS only) were defined as combined approach and single modality, respectively, and all eligible patients were divided into a combined approach group and a single modality group. We compared combined vs. single modality approaches to investigate whether there were statistical differences in liver chemistries, postoperative adverse events, and stent patency time.ResultsIn 271 patients, a total of 356 times endoscopic biliary drainages were performed. All eligible patients were divided into the combined approach group (n = 74) and the single modality group (n = 271). The combined approach was associated with a lower incidence of postoperative cholangitis and bleeding and greater improvement in liver chemistries, although it was not statistically significant. However, it was superior to the single modality group in terms of hospital stay (12.7 ± 5.2 vs. 14.5 ± 7.9 days, p = 0.020 < 0.05) and stent patency time (8.1 ± 3.9 vs. 4.3±2.7 months, p = 0.001 < 0.05).ConclusionEndoscopic combined (ENBD plus stent) drainage is a more advantageous biliary drainage method that is characterized by more adequate biliary drainage, a lower incidence of postoperative adverse events, and longer effective biliary drainage time.
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Olecki EJ, Swinarska J, Perez Holguin RA, Stahl KA, Wong WG, Peng JS, Dixon MEB. Is preoperative biliary stenting associated with increased rate of postoperative complications for patients undergoing pancreatoduodenectomy? A review of national surgical quality improvement program data. HPB (Oxford) 2022; 24:1501-1510. [PMID: 35135722 DOI: 10.1016/j.hpb.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/02/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Jaundice in the setting of periampullary neoplasms is often treated with biliary stenting. Level 1 data demonstrated an increase in perioperative complications after pancreaticoduodenectomy in patients undergoing stent placement. However, the impact of this data on practice patterns in the US remains unknown. METHODS The National Surgical Quality Improvement Program (NSQIP) Pancreatectomy Targeted Participant Use Data File was used to identify patients from 2014 to 2017 undergoing pancreatoduodenectomy. Chi-square test and multivariable logistic regression were used to compare outcomes between those with biliary stent and those without. RESULTS Of the 5524 patients, 3321 (60.1%) had biliary stent placement. The stent group was older, had a higher ASA class, and had preoperative weight loss compared to the group without biliary stenting (all p < 0.05). When adjusting for demographic and operative characteristics, the non-stent group had lower associated overall complications and postoperative infections. There was no significant difference in mortality and pancreatic fistula rate between groups. CONCLUSION Preoperative biliary stenting is still common prior to pancreaticoduodenectomy. With a trend toward increased utilization of neoadjuvant chemotherapy, stenting will likely remain a common practice. Recognition of increased rates of complications associated with stent placement allows for appropriate risk-benefit analysis.
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Affiliation(s)
- Elizabeth J Olecki
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Joanna Swinarska
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Kelly A Stahl
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - June S Peng
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA; Division of Surgical Oncology, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Matthew E B Dixon
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA; Division of Surgical Oncology, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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Hinojosa Arco LC, Roldán de la Rua JF, Carranque Chaves GÁ, Mora Navas L, de Luna Díaz R, Suárez Muñoz MÁ. Intraoperative gram staining of bile for the prevention of infectious complications in pancreaticoduodenectomy. Cir Esp 2022; 100:472-480. [PMID: 35584762 DOI: 10.1016/j.cireng.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/14/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Infectious complications play a prominent role in pancreaticoduodenectomy. Their incidence increases in cases with preoperative biliary drainage (PBD), due to the higher risk of bacterobilia. The aim of this study is to evaluate an antibiotherapy protocol based on intraoperative gram staining of bile and its impact on postoperative infectious complications. METHODS A retrospective study analysing the incidence of infectious complications between two groups of 25 consecutive patients undergoing pancreaticoduodenectomy. In group 1, cefazolin prophylaxis was administered to patients without PBD. In cases with PBD a five days antibiotherapy with piperacillin-tazobactam was administered. In group 2, intraoperative gram staining of bile was routinely performed. If no microorganisms were detected, antibiotherapy was limited to cefazolin prophylaxis. If bacterobilia was detected, targeted antibiotherapy was administered for five days. RESULTS The incidence of sepsis and organ/space infection in group 2 was 4% compared to 32% and 24% in group 1 respectively (p < 0.05). No differences were observed in the remaining morbimortality variables. The most prevalent microorganisms in bile were Enterococcus spp. and Klebsiella spp. In postoperative samples, they only appeared in 4% of cases in group 2 (p < 0.05), in favour of S. epidermidis, although they were also prevalent in group 1 (28 and 24% respectively). CONCLUSION Intraoperative gram staining of bile fluid could be a useful tool to conduct personalised antibiotic therapy in pancreaticoduodenectomy and contribute to the control of infectious complications.
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Affiliation(s)
| | | | | | - Laura Mora Navas
- Servicio de Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Resi de Luna Díaz
- Servicio de Cirugía General y Digestiva, Hospital Virgen de la Victoria, Málaga, Spain
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Analysis of the Bacterial Spectrum and Key Clinical Factors of Biliary Tract Infection in Patients with Malignant Obstructive Jaundice after PTCD. DISEASE MARKERS 2022; 2022:1026254. [PMID: 35942130 PMCID: PMC9356864 DOI: 10.1155/2022/1026254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
Objective To analyze the bacterial spectrum and key clinical factors associated with biliary tract infections following percutaneous transhepatic cholangial drainage (PTCD) for malignant obstructive jaundice (MOJ). Methods This retrospective study comprised patients with MOJ who were treated with PTCD from 1st June 2016 to 31st December 2020. Patient clinical data, development of postprocedure biliary tract infections, spectrum of pathogenic bacteria, and drug sensitivity were analyzed, focusing on antibiotic drug resistance and identifying key associated risk factors for postoperative biliary tract infections. Results Of the 528 study patients, 80 were diagnosed with postoperative biliary tract infections, 58 of whom had pathogenic bacteria detected in their bile samples. A total of 90 strains of pathogenic bacteria and 3 strains of fungi were detected; the top 4 were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, and Pseudomonas aeruginosa. By univariate analysis, a positive bile culture following PTCD was closely correlated with both the location and degree of preoperative obstruction and the preoperative bilirubin level. Moreover, the results of logistic regression analysis concluded that complete obstruction and a high preoperative total bilirubin level prior to PTCD were independent risk factors for a positive bile culture following PTCD. Conclusion Biliary tract infections following PTCD for MOJ were principally due to Escherichia coli, and bacteria in the bile were statistically more likely to be detected in patients with complete obstruction and high preoperative bilirubin levels.
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Stupin V, Abramov I, Gahramanov T, Kovalenko A, Manturova N, Litvitskiy P, Balkizov Z, Silina E. Comparative Study of the Results of Operations in Patients with Tumor and Non-Tumor Obstructive Jaundice Who Received and Did Not Receive Antioxidant Therapy for the Correction of Endotoxemia, Glycolysis, and Oxidative Stress. Antioxidants (Basel) 2022; 11:antiox11061203. [PMID: 35740100 PMCID: PMC9219634 DOI: 10.3390/antiox11061203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To compare the results of surgical treatment and changes in biomarkers of cholestasis, endotoxicosis, cytolysis, lipid peroxidation, glycolysis disorders, and inflammation in patients with benign and malignant obstructive jaundice (OJ) in patients receiving and not receiving antioxidant pharmacotherapy (AOT). Patients and methods: The study included 113 patients (aged 21–90 years; 47 males and 66 females) who received surgical intervention for OJ due to non-malignant (71%) or malignant tumor (29%) etiologies. Patients were divided into two groups: Group I (n = 61) who did not receive AOT and Group II (n = 51) who received AOT (succinate-containing drug Reamberin) as part of detoxification infusion therapy. The surgical approach and scope of interventions in both groups were identical. Dynamic indicators of endotoxicosis, cholestasis, and cytolysis (total, direct, and indirect bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [AP] and gamma-glutamyltransferase [GGT]), kidney function (urea), lipid peroxidation (malonic dialdehyde, MDA), inflammation (leukocytosis), and glycolysis disorders (lactate dehydrogenase (LDH), glucose) were evaluated. Results: Tumor jaundice, unlike non-tumor jaundice, persisted and was characterized by a more severe course, a higher level of hyperbilirubinemia, and lipid peroxidation. The prognostic value of the direct (and total) bilirubin, MDA, glycemia, and leukocytosis levels on the day of hospitalization, which increased significantly in severe jaundice and, especially, in deceased patients, was established. Decompression interventions significantly reduced levels of markers of liver failure, cytolysis, cholestasis, and lipid peroxidation on day 3 after decompression by 1.5–3 times from initial levels; this is better achieved in non-tumor OJ. However, 8 days after decompression, most patients did not normalize the parameters studied in both groups. AOT favorably influenced the dynamics (on day 8 after decompression) of total and direct bilirubin, ALT, AST, MDA, and leukocytosis in non-tumor jaundice, as well as the dynamics of direct bilirubin, AST, MDA, glucose, and LDH in tumor jaundice. Clinically, in the AOT group, a two-fold reduction in the operative and non-operative complications was recorded (from 23% to 11.5%), a reduction in the duration of biliary drainage by 30%, the length of stay in intensive care units was reduced by 5 days, and even hospital mortality decreased, especially in malignancy-induced OJ. Conclusion: A mechanism for the development of liver failure in OJ is oxidative stress with the appearance of enhanced lipid peroxidation and accompanied by hepatocyte necrosis. Inclusion of AOT in perioperative treatment in these patients improves treatment outcomes.
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Affiliation(s)
- Victor Stupin
- Department of Hospital Surgery No.1, N.I. Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (V.S.); (I.A.); (T.G.); (N.M.); (Z.B.)
| | - Igor Abramov
- Department of Hospital Surgery No.1, N.I. Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (V.S.); (I.A.); (T.G.); (N.M.); (Z.B.)
| | - Teymur Gahramanov
- Department of Hospital Surgery No.1, N.I. Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (V.S.); (I.A.); (T.G.); (N.M.); (Z.B.)
| | - Alexey Kovalenko
- Chemical Analytical Department, Institute of Toxicology of the Federal Medical and Biological Agency of Russia, 192019 Saint Petersburg, Russia;
| | - Natalia Manturova
- Department of Hospital Surgery No.1, N.I. Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (V.S.); (I.A.); (T.G.); (N.M.); (Z.B.)
| | - Petr Litvitskiy
- Institute of Biodesign and Modeling of Complex Systems, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
| | - Zalim Balkizov
- Department of Hospital Surgery No.1, N.I. Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (V.S.); (I.A.); (T.G.); (N.M.); (Z.B.)
| | - Ekaterina Silina
- Institute of Biodesign and Modeling of Complex Systems, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
- Correspondence: ; Tel.: +7-9689559784
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Saffo S, Peng C, Salem R, Taddei T, Nagar A. Impact of Neoadjuvant Chemotherapy and Pretreatment Biliary Drainage for Pancreatic Head Ductal Adenocarcinoma. Dig Dis Sci 2022; 67:1409-1416. [PMID: 33811566 PMCID: PMC8487432 DOI: 10.1007/s10620-021-06967-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related deaths in the USA. Although management strategies have evolved, there are continued controversies about the use of neoadjuvant chemotherapy (NAC) and pretreatment biliary drainage (PBD) in patients with resectable and potentially resectable disease. AIMS We aimed to characterize the practice trends and outcomes for NAC and PBD. METHODS A single-center cohort study was performed. Electronic medical records were reviewed between 2011 and 2019, and 140 patients who had pancreaticoduodenectomy for PDAC were included. Diagnosis, treatment, and outcome data were captured. RESULTS There were no statistically significant temporal trends relating to the use of chemotherapy and PBD. Overall, 41% of patients received NAC and had improved survival, independent of other factors. Of the 71% who received PBD, only 40% had appropriate indications; 30% experienced postprocedure complications, and 34% required reintervention. Factors associated with the application of PBD included preoperative jaundice (OR 70.5, 95% CI 21.4-306.6) and evaluation by non-tertiary therapeutic endoscopists (OR 3.9, 95% CI 1.3-13.6). PBD was associated with a 12-day delay in surgery among those who did not receive NAC (p = 0.005), but there were no differences in surgical complications or mortality. CONCLUSIONS Our findings suggest that (1) NAC may confer a survival benefit and (2) PBD should be reserved for individuals with jaundice requiring NAC. Implementation of guidelines by North American gastroenterology societies, multidisciplinary treatment models, and delivery of care at high-volume tertiary centers may help optimize management.
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Affiliation(s)
- Saad Saffo
- Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT, 06520-8019, USA.
| | - Chengwei Peng
- Department of Hematology and Oncology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ronald Salem
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tamar Taddei
- Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT, 06520-8019, USA
- West Haven Veteran Affairs Medical Center, West Haven, CT, USA
| | - Anil Nagar
- Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT, 06520-8019, USA
- West Haven Veteran Affairs Medical Center, West Haven, CT, USA
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Ikarashi D, Tamada S, Tsuyukubo T, Ono S, Fujisawa H, Obara W. Advance renal pelvic cancer caused obstructive jaundice: A case report. Urol Case Rep 2022; 43:102080. [PMID: 35497506 PMCID: PMC9038567 DOI: 10.1016/j.eucr.2022.102080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Abstract
We report a case of advanced renal pelvic cancer in a 69-year-old woman who presented with fatigue, appetite loss, and yellow sclera. Contrast-enhanced computed tomography revealed a large lesion mass extending from the right renal pelvis to the duodenum and surrounding enlarged lymph nodes. Gastroduodenal endoscopy revealed a mass in the ampulla of Vater, and an endoscopic biopsy was performed. Histological and immunohistochemical examination of the biopsy specimen confirmed a diagnosis of urothelial carcinoma. To the best of our knowledge, this is the first report of advanced renal pelvic cancer causing obstructive jaundice.
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Krueger CM, Chikhladze S, Adam U, Patrzyk M, Kramer A, Riediger H. The clinical impact of preoperative biliary drainage on isolated infectious complications (iiC) after pancreatic head resection—a retrospective study. BMC Surg 2022; 22:71. [PMID: 35219316 PMCID: PMC8882266 DOI: 10.1186/s12893-021-01366-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The perioperative morbidity after pancreatoduodenectomy (PD) is mostly influenced by intraabdominal complications which are often associated with infections. In patients with preoperative biliary drainage (PBD), the risk for postoperative infections may be even elevated. The aim of this study is to explore if isolated infectious complications without intraabdominal focus (iiC) can be observed after PD and if they are associated to PBD and antibiotic prophylaxis with potential conclusions for their treatment.
Methods
During a 10-year period from 2009 to 2019, all consecutive PD were enrolled prospectively in a database and analyzed retrospectively. Bacteriobilia (BB) and Fungibilia (FB) were examined by intraoperatively acquired smears. A perioperative antibiotic prophylaxis was performed by Ampicillin/Sulbactam. For this study, iiC were defined as postoperative infections like surgical site infection (SSI), pneumonia, unknown origin etc. Statistics were performed by Fisher’s exact test and Mann Whitney U test.
Results
A total of 426 PD were performed at the Vivantes Humboldt-hospital. The morbidity was 56% (n = 238). iiC occurred in 93 patients (22%) and accounted for 38% in the subgroup of patients with postoperative complications. They were not significantly related to BB and PBD but to FB. The subgroup of SSI, however, had a significant relationship to BB and FB with a poly microbial profile and an accumulation of E. faecalis, E. faecium, Enterobacter, and Candida. BB was significantly more frequent in longer lay of PBD. Resistance to standard PAP and co-existing resistance to broad spectrum antibiotics is frequently found in patients with iiC. The clinical severity of iiC was mostly low and non-invasive therapy was adequate. Their treatment led to a significant prolongation of the hospital stay.
Conclusions
iiC are a frequent problem after PD, but only in SSI a significant association to BB and FB can be found in our data. Therefore, the higher resistance of the bacterial species to routine PAP, does not justify broad spectrum prophylaxis. However, the identification of high-risk patients with BB and PBD (length of lay) is recommended. In case of postoperative infections, an early application of broad-spectrum antibiotics and adaption to microbiological findings from intraoperatively smears may be advantageous.
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Gao Z, Wang J, Shen S, Bo X, Suo T, Ni X, Liu H, Huang L, Liu H. The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center. World J Surg Oncol 2022; 20:7. [PMID: 34991594 PMCID: PMC8734159 DOI: 10.1186/s12957-021-02476-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD. METHODS All consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed. RESULTS A total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001-1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications. CONCLUSIONS PBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice. TRIAL REGISTRATION ClinicalTrials.gov, 2018ZSLC 24 . Registered May 17, 2018, https://clinicaltrials.gov/ .
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Affiliation(s)
- Zhihui Gao
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jie Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaobo Bo
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Tao Suo
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaoling Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Lihong Huang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Houbao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Chinikar R, Patricio D, Gosse J, Ickx B, Delhaye M, Closset J, El Moussaoui I, Hites M, Navez J. Perioperative antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy: retrospective analysis of bacteriological profile and susceptibility. Acta Chir Belg 2021:1-8. [PMID: 34779697 DOI: 10.1080/00015458.2021.2006887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pancreatic tumours are frequently associated with obstructive jaundice requiring preoperative biliary drainage (PBD) before pancreatoduodenectomy (PD), exposing patients to infectious complications. This study aims to compare postoperative complications after PD with or without PBD and to analyse bile bacteriology and antibiotic susceptibility. METHODS All patients undergoing PD between 2014 and 2019 were retrospectively evaluated, and postoperative outcomes were compared according to PBD use. Prophylactic narrow-spectrum antibiotic therapy was given for 24 h, then adapted according to bacteriologic profile. Intraoperative bile cultures and antibiograms were collected. RESULTS Among 164 patients with intraoperative bile culture during PD (75 PBD+, 89 PBD-), an infected bile was observed in 95% and 70% of PBD + and PBD- groups, respectively (p < 0.001). Postoperative mortality and severe morbidity including infectious complications were similar between groups (5% and 15%). The median duration of antibiotherapy was longer in PBD + compared to PBD- groups (9 vs. 2 days, p = 0.009). Malignant indication and PBD were associated with bile contamination using univariate analysis, and PBD was significantly relevant at multivariate analysis. Most common pathogens identified in bile cultures were Escherichia coli, Klebsiella spp. and Enterobacter spp. Overall antibiotic susceptibility to commonly used antibiotics was decreased, including those used in our local guidelines. CONCLUSIONS PBD exposes nearly 100% of patients undergoing PD to bile infection and an increased duration of postoperative antimicrobial therapy, without increasing infectious complications in this study. Adaptation of antimicrobial prophylaxis should be further evaluated according to performance of PBD and local epidemiology, in order to avoid overuse of antibiotics.
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Affiliation(s)
- Reza Chinikar
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Surgery, CHU Tivoli, La Louvière, Belgium
| | - Daniel Patricio
- Department of Anesthesiology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Brigitte Ickx
- Department of Anesthesiology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Myriam Delhaye
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Imad El Moussaoui
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maya Hites
- Department of Infectious Diseases, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Darenskaya MA, Gubanov BG, Kolesnikova LI, Kolesnikov SI. Lipid peroxidation functional state changes in patients with obstructive jaundice depending on the level of bilirubin in the blood. Klin Lab Diagn 2021; 66:722-727. [PMID: 35020284 DOI: 10.51620/0869-2084-2021-66-12-722-727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive jaundice (OJ) is the most common syndrome among diseases of the hepatopancreatoduodenal region and is found in 12-45% of cases. OJ may be benign and malignant etiology. Despite the evidence of the participation of bilirubin in reducing the bactericidal properties of neutrophils, there are no data currently on changes in the functioning of the antioxidant defense system depending on the level of bilirubin in the blood of patients with OJ of various origins. Research in this direction reveals the possibility for the development of pathogenetic recommendations for influencing these links of the pathogenesis of the disease. The study included men with OJ of non-malignant (OJNMG) (n = 47; mean age - 52.02 ± 5.18 years) and OJ of malignant genesis (OJMG) (I-II stages of the malignant process) (n = 45; mean age - 53.02 ± 4.8 years), divided into three subgroups, depending on the level of bilirubin in the blood. The indicators of practically healthy men as a control (n = 50, average age - 48.7 ± 3.9 years) were used. Spectrophotometric and statistical research methods were used. A statistically significant decrease of superoxide dismutase, glutathione-S-transferase, glutathione-peroxidase, ceruloplasmin, an increase in the values of diene conjugates, malondialdehyde in the group of patients with OJNMG relative to the control was revealed, regardless of the level of bilirubin in the blood. The presence of malignant genesis of the disease with more intense changes in the studied parameters relative to control is accompanied. Comparison of indicators between groups of patients with OJ of different genesis showed a decrease in the values of glutathione-S-transferase and an increase in the level of diene conjugates in patients with OJMG and the level of bilirubin less than 60 μmol / L, as well as an increase in the content of diene conjugates in patients with OJNMG and a level of bilirubin 60- 200 μmol / L in comparison with the corresponding groups of patients with OJNMG. Thus, both in the groups with OJNMG and in the groups with OJMG, there is a significant decrease in the activity of the main antioxidant enzymes and an increase in lipid peroxidation products, regardless of the level of bilirubin in the blood. The presence of malignant genesis is characterized by more intense differences. The revealed changes can serve as additional criteria for optimizing the diagnosis and treatment of this cohort of patients.
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Affiliation(s)
| | - B G Gubanov
- Scientific Centre for the Family Health and Human Reproduction Problems
| | - L I Kolesnikova
- Scientific Centre for the Family Health and Human Reproduction Problems
| | - S I Kolesnikov
- Scientific Centre for the Family Health and Human Reproduction Problems
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Muraviov P, Zaporozhchenko B, Borodaev I, Kolodiy V, Gorbunov A, Kirpichnikova E, Bacalbasa N, Balescu I, Harhouri M. Diagnostic approach and treatment specificity in patients with focal lesions of the biliopancreatic area complicated by mechanical jaundice. Exp Ther Med 2021; 23:159. [DOI: 10.3892/etm.2021.11082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Petro Muraviov
- Department of Surgery, Odessa National Medical University, 65082 Odessa, Ukraine
| | - Boris Zaporozhchenko
- Department of Surgery, Odessa National Medical University, 65082 Odessa, Ukraine
| | - Igor Borodaev
- Department of Surgery, Odessa National Medical University, 65082 Odessa, Ukraine
| | - V.v. Kolodiy
- Department of Surgery, Odessa National Medical University, 65082 Odessa, Ukraine
| | - Anatoliy Gorbunov
- Department of Surgery, Odessa National Medical University, 65082 Odessa, Ukraine
| | - E.p. Kirpichnikova
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Odessa National Medical University, 65082 Odessa, Ukraine
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, ‘Ponderas’ Academic Hospital, 021188 Bucharest, Romania
| | - Makrem Harhouri
- Department of Surgery, Odessa National Medical University, 65082 Odessa, Ukraine
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Does Preoperative Acute Pancreatitis Inevitably Delay Pancreatoduodenectomy in Patients with Periampullary Tumors? Cancers (Basel) 2021; 13:cancers13246289. [PMID: 34944909 PMCID: PMC8699028 DOI: 10.3390/cancers13246289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Acute pancreatitis can occur preoperatively in patients with periampullary tumors and cause technical difficulties in performing pancreatoduodenectomy. The aim of this retrospective study was to investigate how preoperative acute pancreatitis would affect postoperative outcomes and to identify the optimal timing of surgery. There were more patients with operation failure (only exploration or unintended total pancreatectomy) in patients with pancreatitis, but no difference was found in rates of other complications. Moreover, when stratified by the timing of surgery, the surgical outcomes did not differ between the patients with and without pancreatitis. The results imply that in terms of surgical complications, pancreatoduodenectomy could be safely performed in patients with preoperative pancreatitis. Further research is necessary to identify safe conditions and proper timing of surgery for patients with preoperative pancreatitis. Abstract Preoperative acute pancreatitis (PAP) in patients with periampullary tumor can cause technical difficulties when performing pancreatoduodenectomy (PD) but perioperative risks of PAP remain unclear. The purpose of this study was to investigate the impact of PAP on surgical outcomes and determine the optimal timing of PD. Patients undergoing surgery for periampullary tumors between 2009 and 2018 were included. Simple random sampling (1:4) was performed to compare outcomes between the PAP group and the control group. Operative failure was defined as exploration-only or unwanted total pancreatectomy. The rate of operative failure was higher in the PAP group than in the control group (6.6% vs. 0%, p < 0.001). There was no significant difference in postoperative outcomes including complications or in-hospital mortality between the two groups. Surgical outcomes were compared after dividing PAP groups by intervals (2, 3, or 4 weeks) between the onset of PAP and surgery, and there were no differences between the groups. In conclusion, in spite of the increased risk of operation failure, PD could be performed in PAP patients at comparable rates of postoperative complications. Further study is needed to select patients with PAP in proper conditions for performing PD.
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47
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Gong S, Song S, Cheng Q, Huang Y, Tian H, Jing W, Lei C, Yang W, Yang K, Guo T. Efficacy and safety of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy: an updated systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1411-1426. [PMID: 34886725 DOI: 10.1080/17474124.2021.2013805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of preoperative biliary drainage (PBD) on outcomes of pancreaticoduodenectomy (PD) in patients with biliary obstruction. METHODS We searched PubMed, EMBASE, Cochrane library, and Web of Science from database inception to 11 March 2021. We used the ROBINS-I tool and Cochrane risk of bias tool 2.0 to assess the risk of bias. The data were statistically analyzed using the RevMan software (Version 5.4). RESULTS In all, 43 studies, including 23,076 patients, were analyzed, of which 13,922 patients were treated with PBD and 9154 were treated with no preoperative biliary drainage (NPBD). The morbidity , infection morbidity , and postoperative pancreatic fistulae (POPF) in patients undergoing PBD, were significantly higher than those in patients undergoing NPBD. Further, PBD may lead to a significantly worse 2- and 3-year overall survival (OS) rates . In subgroup meta-analysis, the differences in morbidity, POPF, and OS outcomes lost significance between the PBD and NPBD groups when the mean total serum bilirubin (TSB) concentration was below 15 mg/dl. CONCLUSIONS Routine PBD still cannot be recommended because it showed no beneficial effect on postoperative outcomes. However, in patients with < 15 mg/dl TSB concentration, PBD tends to be a better choice.
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Affiliation(s)
- Shiyi Gong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Shaoming Song
- Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Qinghao Cheng
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Yunxia Huang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China
| | - Hongwei Tian
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Wutang Jing
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Caining Lei
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wenwen Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Kehu Yang
- Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Evidence-Based Medicine Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
| | - Tiankang Guo
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
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Yamashita H, Nishiyama M, Ohbuchi K, Kanno H, Tsuchiya K, Yamaguchi J, Mizuno T, Ebata T, Nagino M, Yokoyama Y. Predicting Inchinkoto efficacy, in patients with obstructive jaundice associated with malignant tumors, through pharmacomicrobiomics. Pharmacol Res 2021; 175:105981. [PMID: 34798264 DOI: 10.1016/j.phrs.2021.105981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
Inchinkoto (ICKT) is a popular choleretic and hepatoprotective herbal medicine that is widely used in Japan. Geniposide, a major ingredient of ICKT, is metabolized to genipin by gut microbiota, which exerts a choleretic effect. This study investigates the relationship between stool genipin-producing activity and diversity of the clinical effect of ICKT in patients with malignant obstructive jaundice. Fifty-two patients with malignant obstructive jaundice who underwent external biliary drainage were included. ICKT was administered as three packets per day (7.5 g/day) for three days and 2.5 g on the morning of the fourth day. Stool samples were collected before ICKT administration and bile flow was monitored on a daily basis. The microbiome, genipin-producing activity, and organic acids in stools were analyzed. The Shannon-Wiener (SW) index was calculated to evaluate gut microbiome diversity. The stool genipin-producing activity showed a significant positive correlation with the SW index. Stool genipin-producing activity positively correlated with the order Clostridia (obligate anaerobes), but negatively correlated with the order Lactobacillales (facultative anaerobes). Moreover, stool genipin-producing activity was positively correlated to the concentration valeric acid, but negatively correlated to the concentration of lactic acid and succinic acid. The change of bile flow at 2 and 3 days after ICKT administration showed significant positive correlation with genipin-producing activity (correlation coefficient, 0.40 and 0.29, respectively, P < 0.05). An analysis of stool profile, including stool genipin-producing activity, may predict the efficacy of ICKT. Modification of the microbiome may be a target to enhance the therapeutic effect of ICKT.
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Affiliation(s)
- Hiromasa Yamashita
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mitsue Nishiyama
- Tsumura Advanced Technology Research Laboratories, Tsumura & Co., Ami-machi, Ibaraki, Japan
| | - Katsuya Ohbuchi
- Tsumura Advanced Technology Research Laboratories, Tsumura & Co., Ami-machi, Ibaraki, Japan
| | - Hitomi Kanno
- Tsumura Advanced Technology Research Laboratories, Tsumura & Co., Ami-machi, Ibaraki, Japan
| | - Kazuaki Tsuchiya
- Tsumura Advanced Technology Research Laboratories, Tsumura & Co., Ami-machi, Ibaraki, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masato Nagino
- Department of Gastrointestinal Surgery, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
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49
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Sung MK, Park Y, Kwak BJ, Jun E, Lee W, Song KB, Lee JH, Hwang DW, Kim SC. Comparison of Characteristics and Survival Rates of Resectable Pancreatic Ductal Adenocarcinoma according to Tumor Location. Biomedicines 2021; 9:1706. [PMID: 34829935 PMCID: PMC8615679 DOI: 10.3390/biomedicines9111706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 12/25/2022] Open
Abstract
The impact of tumor location on patient survival in pancreatic ductal adenocarcinoma (PDAC) remains controversial. This study investigated the association between primary tumor location and survival rates for resectable PDAC. Additionally, we assessed if this association remains consistent across categories of the Tumor-Node-Metastasis staging system. We analyzed 2471 patients who underwent surgical resection between 2000 and 2018 at a single center. Subgroup analysis was performed according to the Tumor-Node-Metastasis staging system. Among the group, 67.9% (1677 patients) had pancreatic head cancer (PHC) and 32.1% (794 patients) had pancreatic body/tail cancer (PBTC). Patients with PHC had worse overall survival and worse disease-free survival than those with PBTC. Patients with PHC had worse survival in stage IB and stage IIB than those with PBTC. No significant difference was observed for stages IA, IIA, and III. Multivariate analysis showed that elevated CA 19-9, mGPS, a longer hospital stay, complication, accompanying vein resection, larger tumor size, worse differentiation, higher TNM stage (stage IIB, III, IV), presence of LVI, and positive resection margin were risk factors for poor survival after resection. In resectable PDAC, patients with PHC had worse overall and disease-free survival than those with PBTC. However, tumor location was not an independent prognostic factor for PDAC.
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Affiliation(s)
- Min Kyu Sung
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Yejong Park
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Bong Jun Kwak
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Eunsung Jun
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
- Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Woohyung Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Ki Byung Song
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (M.K.S.); (Y.P.); (B.J.K.); (E.J.); (W.L.); (K.B.S.); (J.H.L.); (D.W.H.)
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50
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Lam R, Muniraj T. Fully covered metal biliary stents: A review of the literature. World J Gastroenterol 2021; 27:6357-6373. [PMID: 34720527 PMCID: PMC8517778 DOI: 10.3748/wjg.v27.i38.6357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Fully covered self-expandable metal stents (FCSEMS) represent the latest advancement of metal biliary stents used to endoscopically treat a variety of obstructive biliary pathology. A large stent diameter and synthetic covering over the tubular mesh prolong stent patency and reduce risk for tissue hyperplasia and tumor ingrowth. Additionally, FCSEMS can be easily removed. All these features address issues faced by plastic and uncovered metal stents. The purpose of this paper is to comprehensively review the application of FCSEMS in benign and malignant biliary strictures, biliary leak, and post-sphincterotomy bleeding.
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Affiliation(s)
- Robert Lam
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Thiruvengadam Muniraj
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, United States
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