The clinical impact of the systolic volume variation guided intraoperative fluid administration regimen on surgical outcomes after pancreaticoduodenectomy: a retrospective cohort study

Abstract Background Pancreaticoduodenectomy is associated with high morbidity. Many preoperative variables are risk factors for postoperative complications, but they are primarily non-modifiable. It is not clear whether an intraoperative goal-directed fluid regimen might be associated with fewer postoperative surgical complications compared to current conservative, non-goal-directed fluid practices. We hypothesize that the use of Systolic Volume Variation (SVV)-guided intraoperative fluid administration might be beneficial. Methods Data from 223 patients who underwent pancreaticoduodenectomy in our institution between 2015 and 2019 were reviewed. Patients were classified into two groups based on the use of intraoperative use of SVV to guide the administration of fluids. The decision to use SVV or not was made by the attending anesthesiologist. Subjects were classified into SVV-guided intraoperative fluid therapy (SVV group) and non-SVV-guided intraoperative fluid therapy (non-SVV group). Uni and multivariate regression analyses were conducted to determine if SVV-guided fluid therapy was significantly associated with a lower incidence of postoperative surgical complications, such as Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), among others, after adjusting for confounders. Results Baseline, demographic, and intraoperative characteristics were similar between SVV and non-SVV groups. In the multivariate analysis, the use of SVV guidance was significantly associated with fewer postoperative surgical complications (OR = 0.48; 95% CI 0.25-0.91; p= 0.025), even after adjusting for significant covariates, such as perioperative use of epidural, pancreatic gland parenchyma texture, and diameter of the pancreatic duct. Conclusions VV-guided intraoperative fluid administration might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy.

A retrospective analysis of neuroendocrine tumour of pancreas: a single institute study.

Background: The aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs). This article deals with the classification of the Pancreatic Neuroendocrine Tumors (PNETs) and discusses their presentation, behaviour, treatment and prognosis. Methods: This was a retrospective study of 70 patients of PNET done over a period of 3 years in The Gujarat Cancer and Research Institute, Ahmedabad. 24 patients who underwent surgical treatment for PNET were further evaluated for surgical outcome, 5yr disease free survival and overall survival. Results: In this study of 70 patients, 61(87.14%) were non-functional. Approximately 77% of PNETs were advanced on presentation (57% metastatic and 20% locally advanced). 20 patients had disease resectable on presentation (11 NF + 9 F). These 20 patients belong to stage I and II of TNM staging system. Only 4 out of 40 metastatic diseases had locally resectable tumor. Of 24 patients who underwent surgery, 12 underwent pancreatico-duodenectomy, 6 underwent enucleation and 6 underwent distal pancreatectomy. Conclusions: PNETs are uncommon tumor of pancreatic origin with presentation more commonly in males than females, usually in the 5th decade. Approximately 77% of patients are advanced or metastatic at presentation. Among those resectable, the Overall Survival for FPNETs and NFPNETs was 90% and 94% respectively and 5yr Disease Free Survival for the same was 100% and 84% respectively.

Laparoscopic assisted pancreatico-duodenectomy – Temperature variations.

We have evaluated the incidence of hypothermia during laparoscopic assisted pancreatico duodenectomy in twenty patients. The intravenous infusions, irrigation fluid and CO2 insufflated were not warmed and we lack facilities for patient warming. A mean drop of 1.9 c during laparoscopy over five hours and mean drop of 0.8 0C during the open phase were observed. Therefore warming the infusion and irrigation fluids and warming the patient are recommended to reduce the degree of temperature drop.

Preliminary experience with the uncinate process first for pancreaticoduodenectomy / 中华胰腺病杂志

ObjectiveTo investigate the value of uncinate process first for pancreaticoduodenectomy (PD).MethodsThe clinical data of 19 patients admitted from December 2010 to March 2011,who underwent uncinate process first for PD were studied.ResultsAmong the 19 patients,there were 5 cases of periampullary adenocarcinoma,11 cases of pancreatic cancer,1 case of duodenum aggressive fibromatosis,1 case of main pancreatic duct type IPMN,1 case of SPN.During operation,3 patients (21％) were found to have abnormal or aberrant right hepatic artery.Among the 11 patients with pancreatic cancer,there are Peripancreatic lymph node(3 ～7) metastasis,in 7 cases,and nerve invasion occurred in 8 cases.All the N16 lymph nodes,pancreatic stump,bile duct margin,duodenum and retroperitoneal margin were negative,and all the cases were subjected to R0 resection.The median time for the portal vein blocking was 16 minutes.The average operation time was 4h and there was no major bleeding occurred,and the mean blood loss was 600 ml.No intractable diarrhea occurred post-operatively. Conclusions Uncinate process first for PD offers a comfortable,safe,accurate and controllable method to resect pancreatic head.

Carcinoma mixto adenocarcinoma y neuroendocrino periampular en un paciente con neurofibromatosis tipo 1: Caso clínico / Combined periampullary adenocarcinoma and neuroendocrine tumor in type 1 neurofibromatosis: Report of one case

Neurofibromatosis is a hereditary autosomal-dominant disease, with high rates ofde novo mutations and carries a high risk ofneoplasms. It affects both sexes and all races and ethnic groups. It is characterized by múltiple cutaneous lesions and tumors, both benign and malignant, especially in the nervous system. We report a 52 years old woman with a type 1 neurofibromatosis, presenting with fever, jaundice and weight loss. Onphysical examination, thepatientwasjaundiced and had "café au lait" spots in the skin. A magnetic resonance imaging showed bile duct dilation and a possible ampullarcarcinoma. Thepatientwas operated, duringthe exploration shepresented a periampullary tumor and múltiple small nodular lesions in the stomach, the tumor was resected with a pancreático dúo denectomy and the nodular gastric lesions were biopsied. Thepathological study revealed a combined adenocarcinoma and neuroendocrine duodenal tumor. The study ofthe stomach lesions revealed a gastrointestinal stromal tumor. Four months after surgery, the patient is in good conditions.

Malignant Duodenocolic Fistulas: Report of 2 cases

Malignant duodenocolic fistula is a rare complication of advanced right colon cancer. The surgeon becomes involved not only with the cancer lesion, but also with the physiologic complications, such as electrolyte imbalance and malnutrition. We experienced 2 cases of duodenocolic fistulas arising from right side colon cancers. One of the patients was surgically treated by right hemicolectomy and pancreatico-duodenectomy and another case was lost to follow-up. We report these cases with a brief review of the literature.