BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric...BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric surgery.AIM To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.METHODS EPI was assessed using fecal elastase measurement and classified into:(1)No-EPI(fecal elastase>200μg/g);(2)Moderate EPI(fecal elastase 100–200μg/g);and(3)severe EPI(fecal elastase<100μg/g).QoL was measured using the Gastrointestinal Quality of Life Index(GIQLI)questionnaire.RESULTS Sixteen out of 44(36.4%)patients developed EPI post-operatively:9(56.2%)patients had moderate EPI while 7(43.8%)patients had severe EPI.Severe EPI was more frequently observed in younger patients(5/7:71.4%;P=0.05),in more advanced disease stages(7/7:100%;P=0.05),lymph nodes metastases(7/7:100%;P=0.04)and in the mixed histotypes(4/7:66.7%;P=0.02)compared to the no-EPI and moderate EPI groups.QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score[65(59–92)]compared to the no-EPI/moderate EPI groups[89(84–100)](P=0.002).Lower scores were particularly evident in the core(P<0.0001)and disease-specific symptoms domains(P=0.002)in the severe EPI group compared to the no-EPI/moderate EPI groups.CONCLUSION Gastrectomy is a cause of EPI.Younger patients,aggressive disease and advanced stages are significant risk factors for more severe EPI.Severe EPI worsens QoL,being associated with a higher rate of gastrointestinal symptoms.展开更多
AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS: Si...AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.展开更多
Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical approach.Neoadjuvant treatment(NAT)has become the standard of c...Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical approach.Neoadjuvant treatment(NAT)has become the standard of care to downstage non-metastatic locally advanced PDAC.However,this treatment increases the risk of a nutritional status decline,which in turn,may impact therapeutic tolerance,postoperative outcomes,or even prevent the possibility of surgery.Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications,length of hospital stay,and readmission rate,while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing.Particularly,appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma.In this regard,NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program,aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes.Given these perspectives,this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.展开更多
We read with great interest the article of Rodriguez et al.,"Which method of distal pancreatectomy is cost-effective among open,laparoscopic,or robotic surgery?"(1).In the current climate of limited hospital...We read with great interest the article of Rodriguez et al.,"Which method of distal pancreatectomy is cost-effective among open,laparoscopic,or robotic surgery?"(1).In the current climate of limited hospital sources and control of medical costs,the authors afford the interesting topic of the cost-effectiveness evaluation of the robot-assisted distal pancreatectomy(RDP)in comparison to the laparoscopic(LDP)and open approaches(ODP).To accomplish this purpose,they focused their attention on both the clinical and the economical outcomes of the three different techniques.展开更多
文摘BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric surgery.AIM To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.METHODS EPI was assessed using fecal elastase measurement and classified into:(1)No-EPI(fecal elastase>200μg/g);(2)Moderate EPI(fecal elastase 100–200μg/g);and(3)severe EPI(fecal elastase<100μg/g).QoL was measured using the Gastrointestinal Quality of Life Index(GIQLI)questionnaire.RESULTS Sixteen out of 44(36.4%)patients developed EPI post-operatively:9(56.2%)patients had moderate EPI while 7(43.8%)patients had severe EPI.Severe EPI was more frequently observed in younger patients(5/7:71.4%;P=0.05),in more advanced disease stages(7/7:100%;P=0.05),lymph nodes metastases(7/7:100%;P=0.04)and in the mixed histotypes(4/7:66.7%;P=0.02)compared to the no-EPI and moderate EPI groups.QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score[65(59–92)]compared to the no-EPI/moderate EPI groups[89(84–100)](P=0.002).Lower scores were particularly evident in the core(P<0.0001)and disease-specific symptoms domains(P=0.002)in the severe EPI group compared to the no-EPI/moderate EPI groups.CONCLUSION Gastrectomy is a cause of EPI.Younger patients,aggressive disease and advanced stages are significant risk factors for more severe EPI.Severe EPI worsens QoL,being associated with a higher rate of gastrointestinal symptoms.
文摘AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.
文摘Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical approach.Neoadjuvant treatment(NAT)has become the standard of care to downstage non-metastatic locally advanced PDAC.However,this treatment increases the risk of a nutritional status decline,which in turn,may impact therapeutic tolerance,postoperative outcomes,or even prevent the possibility of surgery.Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications,length of hospital stay,and readmission rate,while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing.Particularly,appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma.In this regard,NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program,aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes.Given these perspectives,this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.
文摘We read with great interest the article of Rodriguez et al.,"Which method of distal pancreatectomy is cost-effective among open,laparoscopic,or robotic surgery?"(1).In the current climate of limited hospital sources and control of medical costs,the authors afford the interesting topic of the cost-effectiveness evaluation of the robot-assisted distal pancreatectomy(RDP)in comparison to the laparoscopic(LDP)and open approaches(ODP).To accomplish this purpose,they focused their attention on both the clinical and the economical outcomes of the three different techniques.
