Permanent Pancreatic Duct Occlusion With Neoprene-based Glue Injection After Pancreatoduodenectomy at High Risk of Pancreatic Fistula: A Prospective Clinical Study.

Abstract:

OBJECTIVE:The aim of this study was to assess safety and efficacy of pancreatic duct occlusion (PDO) with neoprene-based glue in selected patients undergoing pancreatoduodenectomy (PD) at high risk of postoperative pancreatic fistula (POPF). BACKGROUND DATA:PD is the reference standard approach for tumors of the pancreaticoduodenal region. POPF is the most relevant complication after PD. PDO has been proposed as an alternative to anastomosis to manage the pancreatic stump. METHODS:A single-center, prospective, nonrandomized trial enrolled 100 consecutive PD for cancer. Patients at high risk for POPF according to Fistula Risk Score (FRS) >15% (≥6 points) were treated with PDO using neoprene glue (study cohort); patients with FRS ≤15% (≤5 points) received pancreaticojejunal anastomosis (PJA: control cohort). Primary endpoint was complication rate grade ≥3 according to Dindo-Clavien Classification (DCC). Other postoperative outcomes were monitored (ClinicalTrials.gov NCT03738787). RESULTS:Fifty-one patients underwent PDO and 49 PJA. DCC ≥3, postoperative mortality, and POPF grade B-C were 25.5% versus 24.5% (P = 0.91), 5.9% versus 2% (P = 0.62), and 11.8% versus 16.3% (P = 0.51) in the study versus control cohort, respectively. At 1 and 3 years, new-onset diabetes was diagnosed in 13.7% and 36.7% of the study cohort versu 4.2% and 12.2% in controls (P = 0.007). CONCLUSIONS:PDO with neoprene-based glue is a safe technique that equalizes early outcome of selected patients at high risk of POPF to those at low risk undergoing PJA. Neoprene-based PDO, however, triples the risk of diabetes at 1 and 3 years.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Mazzaferro V,Virdis M,Sposito C,Cotsoglou C,Droz Dit Busset M,Bongini M,Flores M,Prinzi N,Coppa J

doi

10.1097/SLA.0000000000003514

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

791-798

issue

5

eissn

0003-4932

issn

1528-1140

journal_volume

270

pub_type

临床试验,杂志文章
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    authors: Williard WC,Hajdu SI,Casper ES,Brennan MF

    更新日期:1992-03-01 00:00:00

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    doi:10.1097/SLA.0000000000001622

    authors: Bolckmans R,Himpens J

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    authors: Bramos A,Perrault D,Yang S,Jung E,Hong YK,Wong AK

    更新日期:2016-08-01 00:00:00

  • Artesunate Protects Against the Organ Injury and Dysfunction Induced by Severe Hemorrhage and Resuscitation.

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    journal_title:Annals of surgery

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    doi:10.1097/SLA.0000000000001664

    authors: Sordi R,Nandra KK,Chiazza F,Johnson FL,Cabrera CP,Torrance HD,Yamada N,Patel NS,Barnes MR,Brohi K,Collino M,Thiemermann C

    更新日期:2017-02-01 00:00:00

  • Intestinal alkaline phosphatase prevents antibiotic-induced susceptibility to enteric pathogens.

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    journal_title:Annals of surgery

    pub_type: 杂志文章

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    authors: Kurian AA,Wang L,Grunkemeier G,Bhayani NH,Swanström LL

    更新日期:2013-09-01 00:00:00

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    更新日期:2012-02-01 00:00:00

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    doi:10.1097/SLA.0b013e3182a53c49

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    更新日期:2013-10-01 00:00:00

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    更新日期:2011-03-01 00:00:00

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    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章

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    更新日期:2009-09-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:2017-12-01 00:00:00

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  • Analysis of the First 100 Patients From the Syrian Civil War Treated in an Israeli District Hospital.

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    pub_type: 杂志文章

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    更新日期:2016-01-01 00:00:00

  • Treatment of 27 postoperative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201-995.

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    pub_type: 杂志文章

    doi:10.1097/00000658-198705000-00015

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    更新日期:1987-05-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:2017-09-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:1986-12-01 00:00:00

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    pub_type: 杂志文章

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    pub_type: 杂志文章

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    pub_type: 临床试验,杂志文章

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    doi:10.1097/00000658-198002000-00018

    authors: McCann RL,Hagen PO,Fuchs JC

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    doi:10.1097/00000658-199204000-00002

    authors: Kaplan EL,Yashiro T,Salti G

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