Delayed gastric emptying in minimally invasive pancreaticoduodenectomy
EAES Academy. Wang S. 07/05/22; 363135; P180
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Abstract
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Background:
Delayed gastric emptying (DGE) is one of the most common and troublesome complications after pancreaticoduodenectomy. The mechanism remains uncertain.
Method:
Patients with periampullary lesions undergoing robotic pancreaticouodenectomy (RPD) or open pancreaticouodenectomy (OPD) were included. A variety of clinical factors were evaluated for the risk of DGE.
Result:
A total of 600 patients with periampullary lesions undergoing pancreaticoduodenectomy were enrolled in the study, including 409 (68.2%) RPD and 191 (31.8%) OPD. Forty-six (7.7%) patients were associated with DGE after pancreaticoduodenectomy. DGE occurred in 46 (7.7%) patients after pancreaticoduodenectomy. Patients presenting with nausea/vomiting tended to have DGE, 12.6% vs. 6.3%, p = 0.019. Patients with preoperative jaundice were associated with higher rate of DGE than those without, 9.9% vs. 5.2%, p = 0.023. Malignancy was a significant factor related to DGE which occurred in 8.7% patients, as compared with only 2.2% in patients with a benign lesion, p = 0.016. Patients with lymph node involvement had a higher rate (9.8%) of DGE than those without (5.6%), p = 0.035. DGE occurred only 4.4% in RPD group, much lower than 14.7% in OPD, p < 0.001. Intraoperative blood loss > 200 c.c. was the other intraoperative factor related to DGE occurring in 11.2%, as compared with 4.4% in those with blood loss < 200 c.c., p = 0.001. PPPD, operation time, vascular resection, and tumor radicality were not significant predictors of DGE. The overall surgical mortality rate was 1.8%. The morbidity rate was 57%, with 12.2% POPF, 5.8% PPH, 23.3% chyle leakage, 1.5% bile leakage, and 6.0% wound infection. None of these postoperative complications was significantly associated with DGE. Hospital stay was significantly longer in the group with DGE than without, 37 vs. 20 days (median), p < 0.001. After multivariate analysis by binary logistic regression, RPD was the only independent factors to be associated with lower incidence of DGE, as compared with OPD
Conclusions:
jaundice, gastrointestinal upset (nausea/vomiting), malignancy, blood loss (> 200 c.c.), lymph node involvement, and OPD (14.7%) are risk factors for DGE after PD. RPD is associated with low incidence (4.4%) of DGE and is the most/only powerful independent predictor for low DGE after multivariate analysis (binary logistic regression).
Delayed gastric emptying (DGE) is one of the most common and troublesome complications after pancreaticoduodenectomy. The mechanism remains uncertain.
Method:
Patients with periampullary lesions undergoing robotic pancreaticouodenectomy (RPD) or open pancreaticouodenectomy (OPD) were included. A variety of clinical factors were evaluated for the risk of DGE.
Result:
A total of 600 patients with periampullary lesions undergoing pancreaticoduodenectomy were enrolled in the study, including 409 (68.2%) RPD and 191 (31.8%) OPD. Forty-six (7.7%) patients were associated with DGE after pancreaticoduodenectomy. DGE occurred in 46 (7.7%) patients after pancreaticoduodenectomy. Patients presenting with nausea/vomiting tended to have DGE, 12.6% vs. 6.3%, p = 0.019. Patients with preoperative jaundice were associated with higher rate of DGE than those without, 9.9% vs. 5.2%, p = 0.023. Malignancy was a significant factor related to DGE which occurred in 8.7% patients, as compared with only 2.2% in patients with a benign lesion, p = 0.016. Patients with lymph node involvement had a higher rate (9.8%) of DGE than those without (5.6%), p = 0.035. DGE occurred only 4.4% in RPD group, much lower than 14.7% in OPD, p < 0.001. Intraoperative blood loss > 200 c.c. was the other intraoperative factor related to DGE occurring in 11.2%, as compared with 4.4% in those with blood loss < 200 c.c., p = 0.001. PPPD, operation time, vascular resection, and tumor radicality were not significant predictors of DGE. The overall surgical mortality rate was 1.8%. The morbidity rate was 57%, with 12.2% POPF, 5.8% PPH, 23.3% chyle leakage, 1.5% bile leakage, and 6.0% wound infection. None of these postoperative complications was significantly associated with DGE. Hospital stay was significantly longer in the group with DGE than without, 37 vs. 20 days (median), p < 0.001. After multivariate analysis by binary logistic regression, RPD was the only independent factors to be associated with lower incidence of DGE, as compared with OPD
Conclusions:
jaundice, gastrointestinal upset (nausea/vomiting), malignancy, blood loss (> 200 c.c.), lymph node involvement, and OPD (14.7%) are risk factors for DGE after PD. RPD is associated with low incidence (4.4%) of DGE and is the most/only powerful independent predictor for low DGE after multivariate analysis (binary logistic regression).
Background:
Delayed gastric emptying (DGE) is one of the most common and troublesome complications after pancreaticoduodenectomy. The mechanism remains uncertain.
Method:
Patients with periampullary lesions undergoing robotic pancreaticouodenectomy (RPD) or open pancreaticouodenectomy (OPD) were included. A variety of clinical factors were evaluated for the risk of DGE.
Result:
A total of 600 patients with periampullary lesions undergoing pancreaticoduodenectomy were enrolled in the study, including 409 (68.2%) RPD and 191 (31.8%) OPD. Forty-six (7.7%) patients were associated with DGE after pancreaticoduodenectomy. DGE occurred in 46 (7.7%) patients after pancreaticoduodenectomy. Patients presenting with nausea/vomiting tended to have DGE, 12.6% vs. 6.3%, p = 0.019. Patients with preoperative jaundice were associated with higher rate of DGE than those without, 9.9% vs. 5.2%, p = 0.023. Malignancy was a significant factor related to DGE which occurred in 8.7% patients, as compared with only 2.2% in patients with a benign lesion, p = 0.016. Patients with lymph node involvement had a higher rate (9.8%) of DGE than those without (5.6%), p = 0.035. DGE occurred only 4.4% in RPD group, much lower than 14.7% in OPD, p < 0.001. Intraoperative blood loss > 200 c.c. was the other intraoperative factor related to DGE occurring in 11.2%, as compared with 4.4% in those with blood loss < 200 c.c., p = 0.001. PPPD, operation time, vascular resection, and tumor radicality were not significant predictors of DGE. The overall surgical mortality rate was 1.8%. The morbidity rate was 57%, with 12.2% POPF, 5.8% PPH, 23.3% chyle leakage, 1.5% bile leakage, and 6.0% wound infection. None of these postoperative complications was significantly associated with DGE. Hospital stay was significantly longer in the group with DGE than without, 37 vs. 20 days (median), p < 0.001. After multivariate analysis by binary logistic regression, RPD was the only independent factors to be associated with lower incidence of DGE, as compared with OPD
Conclusions:
jaundice, gastrointestinal upset (nausea/vomiting), malignancy, blood loss (> 200 c.c.), lymph node involvement, and OPD (14.7%) are risk factors for DGE after PD. RPD is associated with low incidence (4.4%) of DGE and is the most/only powerful independent predictor for low DGE after multivariate analysis (binary logistic regression).
Delayed gastric emptying (DGE) is one of the most common and troublesome complications after pancreaticoduodenectomy. The mechanism remains uncertain.
Method:
Patients with periampullary lesions undergoing robotic pancreaticouodenectomy (RPD) or open pancreaticouodenectomy (OPD) were included. A variety of clinical factors were evaluated for the risk of DGE.
Result:
A total of 600 patients with periampullary lesions undergoing pancreaticoduodenectomy were enrolled in the study, including 409 (68.2%) RPD and 191 (31.8%) OPD. Forty-six (7.7%) patients were associated with DGE after pancreaticoduodenectomy. DGE occurred in 46 (7.7%) patients after pancreaticoduodenectomy. Patients presenting with nausea/vomiting tended to have DGE, 12.6% vs. 6.3%, p = 0.019. Patients with preoperative jaundice were associated with higher rate of DGE than those without, 9.9% vs. 5.2%, p = 0.023. Malignancy was a significant factor related to DGE which occurred in 8.7% patients, as compared with only 2.2% in patients with a benign lesion, p = 0.016. Patients with lymph node involvement had a higher rate (9.8%) of DGE than those without (5.6%), p = 0.035. DGE occurred only 4.4% in RPD group, much lower than 14.7% in OPD, p < 0.001. Intraoperative blood loss > 200 c.c. was the other intraoperative factor related to DGE occurring in 11.2%, as compared with 4.4% in those with blood loss < 200 c.c., p = 0.001. PPPD, operation time, vascular resection, and tumor radicality were not significant predictors of DGE. The overall surgical mortality rate was 1.8%. The morbidity rate was 57%, with 12.2% POPF, 5.8% PPH, 23.3% chyle leakage, 1.5% bile leakage, and 6.0% wound infection. None of these postoperative complications was significantly associated with DGE. Hospital stay was significantly longer in the group with DGE than without, 37 vs. 20 days (median), p < 0.001. After multivariate analysis by binary logistic regression, RPD was the only independent factors to be associated with lower incidence of DGE, as compared with OPD
Conclusions:
jaundice, gastrointestinal upset (nausea/vomiting), malignancy, blood loss (> 200 c.c.), lymph node involvement, and OPD (14.7%) are risk factors for DGE after PD. RPD is associated with low incidence (4.4%) of DGE and is the most/only powerful independent predictor for low DGE after multivariate analysis (binary logistic regression).
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