Standard versus extended pancreaticoduodenectomy in treating adenocarcinoma of the head of the pancreas / 中国医学科学杂志(英文版)

<p><b>OBJECTIVES</b>To compare the postoperative complications and survival of standard pancreatoduodenectomy (SPD) and extended pancreatoduodenectomy (EPD) in patients with resectable adenocarcinoma of the head of the pancreas.</p><p><b>METHODS</b>Between January 1994 and December 2011, 165 patients with biopsy-proven adenocarcinoma of the pancreatic head were treated in West China Hospital, among whom 93 underwent SPD and 72 had EPD. Complications and survival after the surgery were analyzed retrospectively.</p><p><b>RESULTS</b>The median operation time of the EPD group was longer compared with the SPD group (375 minutes vs.310 minutes, P<0.01), the volume of blood transfusion was larger (700 mL vs.400 mL, P<0.05), while the median hospital stay (13.5 days vs.12 days, P=0.79) and the total complication rates were comparable (34.7% vs.32.4%, P=0.93). The total recurrence rates of the SPD and EPD groups were not significantly different (52.7% vs. 43.1%, P=0.83). No significant differences were found between the SPD and EPD groups in 1-year (81.7% vs. 86.1%), 3-year (38.7% vs. 43.1%), 5-year (16.7% vs. 19.4%), and median survivals (19.8 months vs. 23.2 months, P= 0.52).</p><p><b>CONCLUSION</b>The postoperative complications and survival donot differ significantly between SPD and EPD.</p>

Transcatheter arterial embolization for postoperative intraperitoneal and gastrointestinal hemorrhage in a patient with severe acute pancreatitis

Pancreatitis is associated with pseudoaneurysm in 4-10% of patients. Intraperitoneal and gastrointestinal hemorrhage resulting from rupture of a pseudoaneurysm is an uncommon complication of pancreatitis. We report a male with severe acute pancreatitis presenting with intraperitoneal and gastrointestinal hemorrhage 13 days and 68 days after debridement and drainage of infected necrosis of pancreas, which were successfully managed by a transcatheter arterial embolization with "two points" [both sides of the bleeding point]. This case not only reveals the management of intraperitoneal and gastrointestinal hemorrhage, but also indicates "two points" embolization could be the definitive therapy for hemorrhage secondary to severe acute pancreatitis

Management of postoperative acute intraperitoneal and gastrointestinal hemorrhage in patients with severe acute pancreatitis

Acute intraperitoneal and gastrointestinal hemorrhage [AIGH] is a fatal postoperative complication of severe acute pancreatitis [SAP]. Prompt diagnosis and correct treatment of AIGH remain a challenge. The current study presents the procedures undertaken by a single institution in managing postoperative AIGH in patients with SAP. Thirty-four patients with SAP who exhibited AIGH after debridement and drainage of infected necrosis were analyzed retrospectively. Clinical presentations, vessels and accompaniments involved in bleeding, and the diagnostic methods, as well as the therapeutic approaches and outcomes were reviewed. All patients exhibited AIGH 47 times. Fresh blood flowing out from abdominal drains and bloody stools were the predominant [44.9%] symptoms for AIGH. Ten patients that bled several times underwent early surgeries, and 5 of them repeatedly underwent surgeries. Splenic artery was the vessel most commonly involved in bleeding [46.8%]. Seventeen patients bled in one site 23 times, accompanied by gastrointestinal or choledochal fistula. Seventeen patients bled in multiple sites 24 times. AIGH cases were diagnosed successfully by contrast-enhanced computed tomography [51.7%] and arteriography [46.8%]. Transcatheter arterial embolization [TAE] with "one point" was performed 7 times with 5 [71.4%] recurrent bleedings, whereas TAE with "two points" was performed 12 with only 1 [8.3%] re-bleeding. Early surgical intervention and repeated surgery are two risk factors of AIGH. This condition is related to either one-site bleeding accompanied by a gastrointestinal or choledochal fistula or multi-site bleeding. The diagnostic methods and treatments should be selected based on venous or arterial bleeding. A disciplined three-vessel mesenteric arteriogram should be obtained, and TAE with "two points" embolization is recommended to stop arterial bleeding

Inflammatory colonic obstruction developed as a complication of acute gangrenous cholecystitis

Inflammatory colonic obstruction has rarely been reported as a complication of acute gangrenous cholecystitis. In this paper, we report a male presenting with inflammatory colonic obstruction, secondary to acute gangrenous cholecystitis. He was successfully treated with a laparotomy, adhesiolysis and cholecystotomy and went on to make a good recovery. The case highlights the importance of having a high index of suspicion for acute gangrenous cholecystitis accompanied by inflammatory colonic obstruction when reviewing patients presenting with cholecystolithiasis and colonic obstruction in the presence of raised inflammatory markers, as well as having an early surgery

The POSSUM scoring system for risks assessment in pancreatoduodenectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the value of the POSSUM scoring system in predicting postoperative morbidity and mortality of pancreatoduodenectomy (PD).</p><p><b>METHODS</b>Two hundreds and sixty-five consecutive PDs were performed between January 2005 and December 2007. POSSUM scores which relied on 12 physiologic and 6 operative variables were prospectively calculated for each case. Expected morbidity and mortality were estimated based on POSSUM scores and were compared with observed morbidity, which were diagnosed according to the Clavien complication scheme and domestic reference criteria respectively, and mortality.</p><p><b>RESULTS</b>Physiologic scores of 265 cases ranged from 12 to 24,the mean was 15. Operative scores ranged from 14 to 24, the mean was 17. The overall POSSUM scores ranged from 0.24 to 0.88. Average expected morbidity was 43.8%, expected cases were 116. Observed morbidity rate was 39.6% (105/265). The expected and observed morbidities and cases had no significantly differences. All patients were classified to 1 of 4 strata based on their individual POSSUM scores and subsequent risk of morbidity. Predictive value was the highest when scores ranged from 0.4 to 0.8. POSSUM exhibited less predictive value for mortality, but if POSSUM was more than 0.5, it was useful for mortality predicting.</p><p><b>CONCLUSIONS</b>POSSUM scoring system has high value for predicting the risk of morbidity in PD and can be helpful in guiding surgery and postoperative management decisions.</p>

Clinical comparison on the classical versus extensive Whipple's resection for adenocarcinoma of head of pancreas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effect of extensive Whipple's resection to the adenocarcinoma of head of pancreas on the survival, complications, and surgical mortality.</p><p><b>METHOD</b>Ninety three patients who received Whipple's surgery between January 1995 and March 2003 were divided into classical group (n = 51) and extensive group (n = 42). Their short-term outcome and survival rate were compared retrospectively.</p><p><b>RESULTS</b>The postoperative complication rate and mortality in classical group and extensive group were 19.61%/3.92% and 16.67%/2.38%, respectively. And 1- and 2- year survival rates in classical group and extensive group were 58.82%/20.59% and 63.33%/23.33%, respectively.</p><p><b>CONCLUSIONS</b>Postoperative complications and mortality will not increase in extensive Whipple's resection for adenocarcinoma of head of pancreas. However, whether extensive Whipple's resection will improve long-term survival still requires further investigation.</p>