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Updates on Prevention and Management of Pancreatic Surgery Complications
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Updates on Prevention and Management of Pancreatic Surgery Complications

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 (8 December 2022) | Viewed by 9694

Special Issue Editor

Dr. Felix Hüttner

E-Mail Website
Guest Editor
Department of General and Visceral Surgery, Universitätsklinikum Ulm, Ulm, Germany
Interests: pancreatic surgery; surgery outcomes

Special Issue Information

Dear Colleagues,

Pancreatic surgery is considered one of the most technically demanding surgical specialties. Despite this challenge for surgeons, it entails a substantial risk of morbidity for patients undergoing such surgical procedures. Centralization of pancreatic surgery to specialized high-volume centers has led to improvements in mortality rates, but complication rates remain at a high level of 45–60%. Pancreas-specific morbidity is predominantly made up of postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, postoperative acute pancreatitis and intra-abdominal fluid collections or abscesses. Although various technical modifications, e.g., anastomotic techniques after partial pancreatoduodenectomy or remnant closure techniques after distal pancreatectomy, have been developed, reliable prevention of the above-mentioned complications is still lacking. Thus, effective management strategies for complications after pancreatic surgery are of utmost importance in addition to novel approaches for their prevention.

In this Special Issue, current advances in the prevention and management of complications after pancreatic surgery will be presented, illuminating molecular and translational principles as well as clinical strategies in terms of pharmacological, surgical and technical interventions. For this purpose, we invite authors to contribute original articles as well as review articles on this topic.

Dr. Felix Hüttner
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreatic surgery
  • postoperative complications
  • morbidity
  • postoperative pancreatic fistula
  • delayed gastric emptying
  • postpancreatectomy hemorrhage
  • surgical site infections

Published Papers (4 papers)

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Research

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9 pages, 247 KiB  
Article
Risk Factor Identification for Delayed Gastric Emptying after Distal Pancreatectomy—An Evaluation of 1688 Patients Based on the German StuDoQ|Pancreas Registry
by Tim Fahlbusch, Philipp Höhn, Carsten Klinger, Jens Werner, Tobias Keck, Helmut Friess, Jörg Köninger, Thomas W. Kraus, Guido Alsfasser, Winfried Padberg, Jörg-Peter Ritz, Waldemar Uhl and Orlin Belyaev
J. Clin. Med. 2022, 11(19), 5539; https://doi.org/10.3390/jcm11195539 - 21 Sep 2022
Cited by 1 | Viewed by 1084
Abstract
Delayed gastric emptying (DGE) ranks as one of the most frequent complications in pancreatic surgery. It leads to increased costs for healthcare systems, lengthened hospital stays and reduced quality of life. Data about DGE after distal pancreatectomy (DP) are scarce. The StuDoQ|Pancreas registry [...] Read more.
Delayed gastric emptying (DGE) ranks as one of the most frequent complications in pancreatic surgery. It leads to increased costs for healthcare systems, lengthened hospital stays and reduced quality of life. Data about DGE after distal pancreatectomy (DP) are scarce. The StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery provided data of patients who underwent distal pancreatectomy from 1 January 2014 to 31 December 2018. The retrospective evaluation included comprehensive data: 1688 patients were enrolled; DGE occurred 160 times (9.5%); grade “A” was reported for 98 (61.3%), grade “B” for 41 (25.6%) and grade “C” for 21 (13.1%) patients. In univariate analysis pancreatic fistulas were associated with higher frequencies of intraabdominal abscesses (9.1% vs. 2%, p > 0.001), postpancreatectomy haemorrhage (8.1% vs. 3.7%, >0.001) and DGE (14.5% vs. 6%, p < 0.001). According to multivariate analysis, “abscesses with invasive therapy” (p < 0.001), “other surgical complications” (p < 0.001), prolonged “stays in ICU” (p < 0.001), lengthened duration of surgery (p < 0.001) and conventional surgery (p = 0.007) were identified as independent risk factors for DGE. Perioperative and postoperative factors were identified as risk factors for DGE. Following research should examine this highly relevant topic in a prospective, register-based manner. As there is no causal therapy for DGE, its avoidance is of major importance. Full article
(This article belongs to the Special Issue Updates on Prevention and Management of Pancreatic Surgery Complications)

Review

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16 pages, 895 KiB  
Review
Prevention and Treatment of Grade C Postoperative Pancreatic Fistula
by Chengzhi Xiang, Yonghua Chen, Xubao Liu, Zhenjiang Zheng, Haoqi Zhang and Chunlu Tan
J. Clin. Med. 2022, 11(24), 7516; https://doi.org/10.3390/jcm11247516 - 19 Dec 2022
Cited by 3 | Viewed by 4322
Abstract
Postoperative pancreatic fistula (POPF) is a troublesome complication after pancreatic surgeries, and grade C POPF is the most serious situation among pancreatic fistulas. At present, the incidence of grade C POPF varies from less than 1% to greater than 9%, with an extremely [...] Read more.
Postoperative pancreatic fistula (POPF) is a troublesome complication after pancreatic surgeries, and grade C POPF is the most serious situation among pancreatic fistulas. At present, the incidence of grade C POPF varies from less than 1% to greater than 9%, with an extremely high postoperative mortality rate of 25.7%. The patients with grade C POPF finally undergo surgery with a poor prognosis after various failed conservative treatments. Although various surgical and perioperative attempts have been made to reduce the incidence of grade C POPF, the rates of this costly complication have not been significantly diminished. Hearteningly, several related studies have found that intra-abdominal infection from intestinal flora could promote the development of grade C POPF, which would help physicians to better prevent this complication. In this review, we briefly introduced the definition and relevant risk factors for grade C POPF. Moreover, this review discusses the two main pathways, direct intestinal juice spillover and bacterial translocation, by which intestinal microbes enter the abdominal cavity. Based on the abovementioned theory, we summarize the operation techniques and perioperative management of grade C POPF and discuss novel methods and surgical treatments to reverse this dilemma. Full article
(This article belongs to the Special Issue Updates on Prevention and Management of Pancreatic Surgery Complications)
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Other

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23 pages, 886 KiB  
Systematic Review
Perioperative Drug Treatment in Pancreatic Surgery—A Systematic Review and Meta-Analysis
by Ingmar F. Rompen, Daniela C. Merz, Karam T. Alhalabi, Rosa Klotz, Eva Kalkum, Thomas M. Pausch, Hendrik Strothmann and Pascal Probst
J. Clin. Med. 2023, 12(5), 1750; https://doi.org/10.3390/jcm12051750 - 22 Feb 2023
Cited by 2 | Viewed by 2460
Abstract
Introduction: Pancreatic resections for malignant or benign diseases are associated with major morbidity and changes in physiology. To reduce perioperative complications and enhance recovery, many types of perioperative medical management have been introduced. The aim of this study was to provide an evidence-based [...] Read more.
Introduction: Pancreatic resections for malignant or benign diseases are associated with major morbidity and changes in physiology. To reduce perioperative complications and enhance recovery, many types of perioperative medical management have been introduced. The aim of this study was to provide an evidence-based overview on the best perioperative drug treatment. Methods: The electronic bibliographic databases Medline, Embase, CENTRAL, and Web of Science were systematically searched for randomized controlled trials (RCT) evaluating perioperative drug treatments in pancreatic surgery. The investigated drugs were somatostatin analogues, steroids, pancreatic enzyme replacement therapy (PERT), prokinetic therapy, antidiabetic drugs, and proton pump inhibitors (PPI). Targeted outcomes in each drug category were meta-analyzed. Results: A total of 49 RCT were included. The analysis of somatostatin analogues showed a significantly lower incidence of postoperative pancreatic fistula (POPF) in the somatostatin group compared to the control group (OR 0.58, 95% CI: 0.45 to 0.74). The comparison of glucocorticoids versus placebo showed significantly less POPF in the glucocorticoid group (OR 0.22, 95% CI: 0.07 to 0.77). There was no significant difference in DGE when erythromycin was compared to placebo (OR 0.33, 95% CI: 0.08 to 1.30). The other investigated drug regimens could only be analyzed qualitatively. Conclusion: This systematic review provides a comprehensive overview on perioperative drug treatment in pancreatic surgery. Some often-prescribed perioperative drug treatments lack high quality evidence and further research is needed. Full article
(This article belongs to the Special Issue Updates on Prevention and Management of Pancreatic Surgery Complications)
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11 pages, 5917 KiB  
Technical Note
An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
by Yutong Yao, Junjie Xiong, Ziyao Wang, Xing Wang, Xubao Liu and Nengwen Ke
J. Clin. Med. 2023, 12(2), 590; https://doi.org/10.3390/jcm12020590 - 11 Jan 2023
Viewed by 1326
Abstract
The no-touch isolation technique has been widely used in cancer surgery as a strategy to prevent cancer cells from spreading; however, it is difficult to apply in laparoscopic pancreaticoduodenectomy (LPD). Here, we describe an orthotopic resection surgical technique that applies a no-touch principle [...] Read more.
The no-touch isolation technique has been widely used in cancer surgery as a strategy to prevent cancer cells from spreading; however, it is difficult to apply in laparoscopic pancreaticoduodenectomy (LPD). Here, we describe an orthotopic resection surgical technique that applies a no-touch principle for LPD and can help with the in situ resection of tumors. In implementing this surgical strategy, Kocher’s maneuver was not performed first. Instead, after the exploration of the abdominal cavity, the distal stomach and the pancreatic neck were transected. Then, the dissection of the uncinate process of the pancreas, the duodenum, and the superior mesenteric vein and artery is carried out via an inferior infracolic approach. Finally, the pancreatic head and duodenum were removed in situ. Among the 41 patients who underwent this technique, two (4.9%) required conversion to open surgery due to uncontrolled bleeding. The average operative time was 335 min (248–1055 min). The mean estimated blood loss was 300 mL (50–1250 mL). Two patients (4.9%) underwent combined PV resection and reconstruction; six patients (14.6%) required a blood transfusion; two patients (4.9%) suffered from postoperative bleeding; two patients (4.9%) suffered from Grade B pancreatic fistulas; one patient (2.4%) suffered from bile leakage; and three patients (7.3%) suffered from abdominal fluid collection. No patients died during the perioperative period. Therefore, orthotopic LPD using an inferior infracolic approach is safe and feasible for patients with malignant pancreatic head and periampullary tumors. However, further investigations are required to elucidate its oncological benefits. Full article
(This article belongs to the Special Issue Updates on Prevention and Management of Pancreatic Surgery Complications)
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