TY - JOUR
T1 - The clinical impact of early complete pancreatic head devascularisation during pancreatoduodenectomy
AU - Gundara, J. S.
AU - Wang, F.
AU - Alvarado-Bachmann, R.
AU - Williams, N.
AU - Choi, J.
AU - Gananadha, S.
AU - Gill, A. J.
AU - Hugh, T. J.
AU - Samra, J. S.
PY - 2013/10
Y1 - 2013/10
N2 - Background Early inferior pancreaticoduodenal artery (IPDA) ligation reduces intraoperative blood loss during pancreatoduodenectomy, but the impact on oncologic and long-term outcomes remains unknown. The aim of this study was to review the impact of complete pancreatic head devascularization during pancreatoduodenectomy on blood loss, transfusion rates, and clinicopathologic outcomes. Methods Clinicopathologic and outcome data were retrieved from a prospective database for all pancreatoduodenectomies performed from April 2004 to November 2010 and compared between early (IPDA+; n = 62) and late (IPDA-; n = 65) IPDA ligation groups. Results Early IPDA ligation was associated with reduced blood loss (394 ± 21 vs 679 ± 24 ml, P <.001) and perioperative transfusion (P =.031). A trend toward improved R0 resection was seen in patients with pancreatic adenocarcinoma (IPDA+ vs IPDA-, 100% vs 82%; P =.059), but this did not translate to improved 2-year (IPDA+ vs IPDA-, 76% vs 65%; P =.426) or overall (P =.82) survival. Conclusions Early IPDA ligation reduces blood loss and transfusion requirements. Despite overall survival being unchanged, a trend toward improved R0 resection is encouraging and justifies further studies to ascertain the true oncologic significance of this technique.
AB - Background Early inferior pancreaticoduodenal artery (IPDA) ligation reduces intraoperative blood loss during pancreatoduodenectomy, but the impact on oncologic and long-term outcomes remains unknown. The aim of this study was to review the impact of complete pancreatic head devascularization during pancreatoduodenectomy on blood loss, transfusion rates, and clinicopathologic outcomes. Methods Clinicopathologic and outcome data were retrieved from a prospective database for all pancreatoduodenectomies performed from April 2004 to November 2010 and compared between early (IPDA+; n = 62) and late (IPDA-; n = 65) IPDA ligation groups. Results Early IPDA ligation was associated with reduced blood loss (394 ± 21 vs 679 ± 24 ml, P <.001) and perioperative transfusion (P =.031). A trend toward improved R0 resection was seen in patients with pancreatic adenocarcinoma (IPDA+ vs IPDA-, 100% vs 82%; P =.059), but this did not translate to improved 2-year (IPDA+ vs IPDA-, 76% vs 65%; P =.426) or overall (P =.82) survival. Conclusions Early IPDA ligation reduces blood loss and transfusion requirements. Despite overall survival being unchanged, a trend toward improved R0 resection is encouraging and justifies further studies to ascertain the true oncologic significance of this technique.
KW - Artery first
KW - Inferior pancreaticoduodenal artery
KW - IPDA
KW - Pancreatoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=84885040764&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2013.01.040
DO - 10.1016/j.amjsurg.2013.01.040
M3 - Article
C2 - 23809671
AN - SCOPUS:84885040764
SN - 0002-9610
VL - 206
SP - 518
EP - 525
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 4
ER -