Developments in pancreatic surgery at the 1st Surgical Department 1st Faculty of Medicine, Charles University and General University Hospital in Prague
Authors:
Z. Krška; J. Šváb
Authors‘ workplace:
I. chirurgická klinika 1. LF UK a VFN, Praha, přednosta: Prof. MUDr. Zdeněk Krška, CSc.
Published in:
Rozhl. Chir., 2012, roč. 91, č. 5, s. 262-266.
Category:
Original articles
Overview
Introduction:
Surgical treatment of pancreatic diseases has been going through certain changes and developments. This article aims to describe the changes in diagnosis and treatment that have occurred over the years.
Material and methods:
Groups of patients from three different periods (1954–1999, 2002–2006 and 2007–2011), all of them having undergone elective follow-up for the diagnosis of acute or chronic pancreatitis (AP, CHP), pancreas and papilla tumours, terminal choledochus, and other less common tumours in this region, are described. Monitoring has focused on the indication criteria, the extent and method of the surgical procedure, perioperative lethality and morbidity, including complications, and also survival rate.
Results:
In AP patients we recorded a significant drop in indications to surgery (38% vs. 16%), a shift in intervention time from 8.9 to 22.5 days, a decrease in lethality by 24%, or, as the case may be, by 3.5% (yet 7.9% during the first three months). The results show the domination of open abdominal procedures and a rising number of non-interventions. In CHP patients we detected a 30% increase in the number of resection procedures /Whipple/, a slight increase in drainage procedures (by 6%), and a decrease in drainage-resection procedures. The overall drop in the number of procedures in CHP patients probably relates to endoscopic and miniinvasive treatment. In pancreatic tumours we found domination of adenocarcinoma (92.6%), but also an increase in the number of cystic and endocrine tumours (2.6% and 4.8%) as a result of diagnostics and centralisation of care. We also recorded a decrease in exploratory laparotomy cases to 12%. In patients with resectable tumours we performed hemipancreatoduodenectomy in 90%, posterior approach in 2%, and vascular resection in only 4%. Perioperative lethality stagnates around 2.8%. Median survival rate has remained unchanged, as has long-term survival rate.
Conclusion:
Although treatment in general has not recorded any revolutionary and fundamental benefits, its surgical modality still represents the principal treatment and can be considered curative, even in tumours. Pancreatic diseases remain to be seen as a multidisciplinary issue and must be approached and dealt with as such, optimally in large-volume centres.
Key words:
acute pancreatitis – chronic pancreatitis – pancreatic adenocarcinoma – cystic tumours – endocrine tumours
Sources
1. Peskova M, et al. Results of surgical treatment of pancreatic carcinoma. Sb Lek 1996;97,3:391–396.
2. Krška Z, Šváb J. Fulminant acute pankreatitis. Rozhl Chir 2009,88(10):563–7.
3. Uhl W, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565–573.
4. Werner J, et al. Management of acute pancreatitis: from surgery to interventional intensive care. Gut 2005;54:426–436.
5. Gurusamy KS, Farouk M, Tweedie JH. UK guidelines for the management of acute pancreatitis. Gut 2005;54(9):1344–5.
6. Dervenis C. New Atlanta Classification. E-AHPBA Congress, 4,2011:35.
7. Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminat and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol 2007;102(12): 2688–2695.
8. Lilja HE, et al. Utilization of intenzive care unit resources in severe acute pancreatitis. JOP 2008;8,9(2):179–84.
9. Kong L. et al. Clinical characteristics and prognostic factors of severe acute pancreatitis. World J Gastroenterol. 2004,10(22), 3336–3338.
10. Carnoval A, et al. Mortality in acute pancreatitis: is it an early or a late event? JOP 2005;6(5):438–444.
11. Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol 2007;13(38):5043–5051.
12. Mofidi R, et al. Association of early systematic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 2006;93:738–744.
13. Garg PK, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol 2005;3:159–166.
14. Šváb J, et al. Choice of surgical procedure in operations for chronic pancreatitis-personal experience. Sb Lek 2002;103,2: 173–179.
15. Bornman PC, et al. Guidelines for the diagnosis and treatment of chronic pancreatitis SAMJ 2010,100:845–860.
16. Chari ST, Singer MV. The problem of classification and staging of chronic pancreatitis. Proposals based on current knowledge of its natural history. Scand J Gastroenterol 1994;(10):949–60.
17. Ammann RW. Diagnosis and management of chronic pancreatitis: current knowledge. Swiss Med Wkly 2006;136(11-12):166–74.
18. Waxman I, Freedman SD, Zeroogian JM. Endoscopic therapy of chronic and recurrent pankreatitis. Dig Dis 1998;16(3):134–43.
19. Witt H, Apte MV, Keim V, Wilson JS.Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology 2007;132(4):1557–73.
20. Forssmann K, Schirr K, Schmid M, et al. Postoperative follow-up in patients with partial Whipple duodenopancreatectomy for chronic pankreatitis. Z Gastroenterol 1997;35(12):1071–80.
21. Klempa I, Spatny M, Menzel J, et al. Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whippleęs operation. Chirurg 1995;66(4):350–9.
22. Singhai D, Kakodkar R, Sud R, el al. Issues in the management of pancreatic pseudocysts. JOP 2006;7:502–507.
23. Riediger H, et al. Long-term outcome after resection for chronic pancreatitis in 224 patientsJ Gastrointest Surg 2007;11,8:949–9.
24. Nakao A, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30,976–982.
25. Farnell MB, et al. The role of extended lymphadenectomy for adenocarcinoma of the head of the pancreas strength of the evidence. J Gastrointest. Surg 2008;12:651–656.
26. Okabayashi T, et al. Long-term effects of multimodal treatment for patiens with resectable carcinoma of the pankreas. Oncology Reports 2008;20:651–656.
27. Iott MJ, Corsini MM, Miller RC. Evidence-based guidelines for adjuvant therapy for resected adenocarcinoma of the pancreas. Clin J Oncol Nurs 2008;12,4:599–605.
28. Li J, Saif MW. Any progress in the management of advanced pancreatic cancer? Highlights form the 45th ASCO annual meeting. Orlando, 2009, JOP 2009;10,4:361–365.
29. Ho CK, Kleef J, Buchler MW. Complications of pancreatic surgery. HPB 2005;7,2:99–108.
30. Ujiki MB, Talamonti MS. Guidelines for the surgical management of pancreatic adenocarcinoma. Semin Oncol 2007;34,4: 311–320.
31. Cambell F, Azadeli B. Cystic neoplasmas of the exocrine pancreas. Histopathology 2008;52:539–551.
32. Garcea G, Ong SL, Rajesh A, et al. Cystic lesions of the pancreas. Pancreatology 2008;8:236–251.
33. Roggin KK, Chennat J, Oto A, et al. Pancreatic cystic neoplasm. Curr Probl Surg 2010;47:459–510.
34. Thompson NW, Eckhauser FE, Vinik AL, et al. Cystic neuroendocrine neoplasms of the pancreas and liver. Ann Surg 1984;199:158–164.
35. Tien YW, Hu RH, Hung JS, et al. Noninvasive pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy. Ann Surg Oncol 2008;15:193–198.
36. Kurosaki I, et al. Left posterior approach to the superior mesenteric vascular pedicle in pancreaticoduodenectomy for cancer of the pancreatic head. JOP 2011;6,12,3:220–229.
37. Varshney S, et al. Radiofrequency ablation of unresectable pancreatic carcinoma: Feasibility, efficacy and safety. JOP 2006;7, 1:74–78.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
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