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State-of-the-Art in Pancreatic Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 12123

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Special Issue Editors

Dr. Teresa Perra

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Guest Editor

Department of Medicine, Surgery and Pharmacy, Unit of General Surgery, University of Sassari, 07100 Sassari, Italy
Interests: pancreatic cancer; pancreatic ductal adenocarcinoma; pancreatic surgery; hepatobiliary surgery; cholangiocarcinoma; hepatocellular carcinoma; liver metastases; colorectal surgery; surgical oncology
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Prof. Alberto Porcu

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Guest Editor

Special Issue Information

Dear Colleagues,

Pancreatic surgery (PS) is one of the most technically challenging kinds of surgery. Several surgical techniques and different anastomosis for the reconstruction of the digestive system have been performed over the years. PS has been adapted to treat different pancreatic diseases (e.g. cancer, acute or chronic pancreatitis, cysts). Various factors influence cancer recurrance, morbidity and mortality after PS, as scientific literature shows. The most common and clinically relevant complications are related to pancreaticojejunal anastomosis. The choice between neoadjuvant therapy and upfront surgery is dibated, in particular in case of vascular reconstruction. Resectability criteria, absolute and relative contraindications to PS are re-evaluated in the light of new scientific evidence. There are still many unanswered questions and further studies are needed to better manage and treat surgical patients with pancreatic disease. The scope of this Special Issue is to provide an overview of the global advancement of surgical research and clinical practice in the field of PS. Therefore, researchers in the field of PS are encouraged to share their experiences and discuss surgical approaches, submitting an original article or review to this Special Issue.

Dr. Teresa Perra
Prof. Dr. Alberto Porcu
Guest Editors

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Keywords

Pancreatic Surgery
Pancreatoduodenectomy
Pancreatectomy
Pancreatic cancer
Treatment
Management
Complications
Pancreaticojejunal anastomosis
Vascular reconstruction
Neoadjuvant therapy

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Published Papers (5 papers)

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Editorial

Jump to: Research, Review

3 pages, 169 KiB

Open AccessEditorial

State of the Art in Pancreatic Surgery: Some Unanswered Questions

by Teresa Perra and Alberto Porcu

J. Clin. Med. 2022, 11(10), 2821; https://doi.org/10.3390/jcm11102821 - 17 May 2022

Cited by 2 | Viewed by 1399

Abstract

Pancreatic surgery is one of the most technically challenging types of surgery, and many questions remain unanswered; therefore, an overview of the global advancement in surgical research and clinical practice is fundamental in this field [...] Full article

(This article belongs to the Special Issue State-of-the-Art in Pancreatic Surgery)

Research

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12 pages, 1293 KiB

Open AccessArticle

Time to Surgery Does Not Affect Overall or Disease-Free Survival of Patients with Primary Resectable PDAC

by Anne Jacobsen, Mirianna Hobbs, Susanne Merkel, Anke Mittelstädt, Franziska Czubayko, Christian Krautz, Georg F. Weber, Robert Grützmann and Maximilian Brunner

J. Clin. Med. 2022, 11(15), 4433; https://doi.org/10.3390/jcm11154433 - 29 Jul 2022

Cited by 2 | Viewed by 1593

Abstract

(1) Background: Delay in therapy for pancreatic ductal adenocarcinoma (PDAC) may contribute to a worse outcome. The aim of this study was to investigate the prognostic value of time from diagnosis to surgery in patients undergoing upfront surgery for primarily resectable pancreatic carcinoma. (2) Methods: This retrospective single-center study included 214 patients who underwent primary resection of PDAC from January 2000 to December 2018 at University Hospital Erlangen. Using a minimum p-value approach, patients were stratified according to time to surgery (TtS) into two groups: TtS ≤ 23 days and TtS > 23 days. Postoperative outcome and long-term survival were compared. (3) Results: Median TtS was 25 days. The best cut-off for TtS was determined as 23 days. There were no differences regarding postoperative outcome or overall survival (OS) and disease-free survival (DFS) (OS: 23.8 vs. 20.4 months, p = 0.210, respectively, and DFS: 15.8 vs. 13.6 months, p = 0.187). Multivariate analysis revealed age, lymph node metastasis, tumor differentiation and resection status as significant independent prognostic predictors for OS and DFS. (4) Conclusions: A delay of surgery > 23 days after first diagnosis does not affect overall or disease-free survival of patients with primary resectable PDAC. However, the psychological impact of a delay to patients waiting for surgery should not be underestimated. Full article

(This article belongs to the Special Issue State-of-the-Art in Pancreatic Surgery)

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10 pages, 1803 KiB

Open AccessArticle

Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series

by Diana Schlanger, Călin Popa, Andra Ciocan, Cornelia Șofron and Nadim Al Hajjar

J. Clin. Med. 2022, 11(10), 2891; https://doi.org/10.3390/jcm11102891 - 20 May 2022

Cited by 2 | Viewed by 1837

Abstract

(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival. Full article

(This article belongs to the Special Issue State-of-the-Art in Pancreatic Surgery)

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12 pages, 1221 KiB

Open AccessArticle

Evaluation of the Efficacy and Effects of Common Hepatic Artery Reconstruction in Pancreas Transplantation: A Randomized Controlled Trial

by Naohiro Aida, Taihei Ito, Kei Kurihara, Izumi Hiratsuka, Megumi Shibata, Atsushi Suzuki and Takashi Kenmochi

J. Clin. Med. 2022, 11(8), 2258; https://doi.org/10.3390/jcm11082258 - 18 Apr 2022

Cited by 3 | Viewed by 2378

Abstract

Maintenance of postoperative graft flow is important in pancreas transplantation. In Japan, reconstruction of the common hepatic artery is performed primarily to increase perfusion in the pancreatic head. We investigated the effects of common hepatic artery reconstruction on patient and graft survival and endocrine functions. Twenty-nine cases of pancreas transplantation were registered in the clinical trial. Of the 29 cases, four were excluded because of the risk of ischemia without reconstruction or complicated reconstruction due to a narrow artery. A total of 25 cases were randomized into two groups: 13 in the non-reconstructed group and 12 in the reconstructed group. The 1-year patient survival and graft survival rates of the non-reconstructed and reconstructed groups were 92.3% and 83.3%, and 91.7% and 82.5%, respectively. The incidence of complications in the two groups was comparable, with 38.5% (5/13 cases) in the non-reconstructed group and 33.3% (4/12 cases) in the reconstructed group. The results of the glucagon stimulation test and oral glucose tolerance test at 1 month and 1 year post-transplantation were comparable. Common hepatic artery reconstruction is not essential unless there is risk of ischemia. This study was registered at the University Hospital Medical Information Network Clinical Trials Registry under UMIN000027213. Full article

(This article belongs to the Special Issue State-of-the-Art in Pancreatic Surgery)

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Review

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10 pages, 406 KiB

Open AccessReview

Sarcopenia and Risk of Pancreatic Fistula after Pancreatic Surgery: A Systematic Review

by Teresa Perra, Giovanni Sotgiu and Alberto Porcu

J. Clin. Med. 2022, 11(14), 4144; https://doi.org/10.3390/jcm11144144 - 16 Jul 2022

Cited by 7 | Viewed by 2364

Abstract

Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following this type of surgery is debated. The aim of this review was to assess the impact of sarcopenia on the risk of POPF. A literature search was performed using the PubMed database and the reference lists of relevant articles to identify papers about the impact of sarcopenia on POPF in pancreatic surgery. Twenty-one studies published between 2016 and 2021 with a total of 4068 patients were included. Some studies observed a significant difference in the incidence of POPF between the sarcopenic and non-sarcopenic patients undergoing pancreatoduodenectomy. Interestingly, there was a trend of a lower POPF rate in sarcopenic patients than in non-sarcopenic patients. Only one study included patients undergoing distal pancreatectomy specifically. The role of sarcopenia in surgical outcomes is still unclear. A combination of objective CT measurements could be used to predict POPF. It could be assessed by routine preoperative staging CT and could improve preoperative risk stratification in patients undergoing pancreatic surgery. Full article

(This article belongs to the Special Issue State-of-the-Art in Pancreatic Surgery)

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