Preoperative diabetes mellitus does not impact on postoperative morbidity after pancreatic resections for ductal adenocarcinoma

Pancreatology ◽  
2012 ◽  
Vol 12 (6) ◽  
pp. 589-590 ◽  
Author(s):  
G. Malleo ◽  
F. Mazzarella ◽  
A. Malpaga ◽  
G. Marchegiani ◽  
R. Salvia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Morbidity ◽  
Ductal Adenocarcinoma ◽  
Pancreatic Resections

scholarly journals Protective or Risk Factors for Postoperative Pancreatic Fistulas in Malignant Pathology

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1216
Author(s):  
Vasilescu Alin Mihai ◽  
Andriesi Rusu Delia Florina ◽  
Bradea Costel ◽  
Vlad Nutu ◽  
Ursulescu-Lupascu Corina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Protective Factor ◽  
Malignant Tumors ◽  
Fibrous Tissue ◽  
Ductal Adenocarcinoma ◽  
Main Diagnosis ◽  
Entire Study ◽  
Periampullary Adenocarcinoma ◽  
Pancreatic Resections ◽  
Pancreatic Fistulas

Introduction: Malignant tumors are associated with a low incidence of postoperative pancreatic fistulas. The presence of peritumoral fibrosis is considered the protective factor for the development of postoperative pancreatic fistulas after pancreatic resections for pancreatic ductal adenocarcinomas. Methods: We analyzed a series of 109 consecutive patients with pancreatic resections for malignant pathology: pancreatic ductal adenocarcinomas and periampullary adenocarcinomas. The incidence of postoperative pancreatic fistulas has been reported in tumor histological type, in the presence of peritumoral fibrosis, and in the association between adenocarcinomas and areas of acute pancreatitis. The data obtained were processed with the statistical analysis program SPSS, and statistically significant p were considered at a value <0.05. Results: For the entire study group, the incidence of postoperative pancreatic fistulas was 11.01%. The lowest incidence was observed in the group of patients with pancreatic ductal adenocarcinomas (4.06% vs. 25.72% in the group with periampullary adenocarcinoma), with a p = 0.002. The presence of peritumoral fibrous tissue was observed in 49.31% of cases without pancreatic fistulas, and in 54.54% of cases that developed this postoperative complication (p = 0.5). Also, the peritumoral fibrous tissue had a uniform distribution depending on the main diagnosis (56.14% in pancreatic ductal adenocarcinoma group vs. 37.04% in periampullary adenocarcinoma group, with a p = 0.08). In the group of patients who associated areas of acute pancreatitis on the resections, the incidence of postoperative pancreatic fistulas was 7.8 times higher (30% vs. 3.8%, p = 0.026). Conclusions: Peritumoral fibrous tissue was not a factor involved in the developing of postoperative pancreatic fistulas. The association of adenocarciomas with areas of acute pancreatitis has led to a significant increase in postoperative pancreatic fistulas, which is a significant and independent risk factor.

Myosteatosis to predict postoperative morbidity in pancreatic ductal adenocarcinoma patients receiving neoadjuvant chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16754-e16754
Author(s):  
Raphael Louie ◽  
Gabriel Aleixo ◽  
Allison Mary Deal ◽  
Emily Damone ◽  
Jaclyn Tremont-Portelli ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Postoperative Morbidity ◽  
Tube Feeding ◽  
Ct Scans ◽  
Ductal Adenocarcinoma ◽  
Baseline Body Mass Index ◽  
Cross Sectional ◽  
Student’S T ◽  
Morbidity Risk

e16754 Background: Myosteatosis (adipose deposits in muscle) can be detected on cross-sectional imaging through variations in Skeletal Muscle Density (SMD). Patients with myosteatosis tend to have lower overall survival, increased chemotherapy toxicity, and shorter progression-free intervals across cancer types. We investigated whether changes in myosteatosis during neoadjuvant chemotherapy can predict postoperative morbidity risk in patients with pancreatic ductal adenocarcinoma (PDAC). Methods: This is a retrospective cohort study from 2014-2019 of patients with biopsy-proven PDAC who completed neoadjuvant chemotherapy and R0/1 resection (R1: margin < 1mm or microscopically positive). We obtained preoperative patient (age at diagnosis, baseline body mass index (BMI), sex, race, comorbidities) and treatment data (neoadjuvant chemotherapy regimen and duration, time from completion of systemic therapy to surgery, type of operation). Primary outcomes were postoperative complications and 90-day readmission. Average SMD was measured using imaging analysis software at the L3 level on axial abdominal CT scans at the time of diagnosis and at completion of neoadjuvant therapy (SliceOmatic TomoVision QC, Can). We defined SMDΔ as the decrease in SMD during neoadjuvant chemotherapy. Descriptive statistics and Student’s t-test were performed with STATA. Results: We identified 44 patients who received neoadjuvant chemotherapy, achieved a R0/1 resection, and had available CT scans for body composition evaluation. The postoperative complication rate was 43% (n = 19) and 90-day readmission rate was 30% (n = 13). Lower SMD at diagnosis was associated with increased postoperative delirium (p < 0.01) and 90-day readmission (p = 0.02). Greater SMDΔ was associated with increased ICU utilization (p < 0.01) and tube feeding upon discharge (p = 0.03). There was no significant association between preoperative BMI or albumin and our primary outcomes. Conclusions: Preoperative SMD and SMDΔ, rather than albumin or BMI, can predict postoperative morbidity in PDAC patients who received neoadjuvant chemotherapy. This study provides the framework for future studies to develop and validate a tool to predict postoperative morbidity risk in these patients.

Comparing the Burden of Fistulas for Proximal and Distal Pancreatic Resections Using the Postoperative Morbidity Index

2014 ◽  
Vol 186 (2) ◽  
pp. 628
Author(s):  
M.T. McMillan ◽  
B.C. Miller ◽  
S.W. Behrman ◽  
J.D. Christein ◽  
M.P. Callery ◽  
...  
Keyword(s):  
Postoperative Morbidity ◽  
Pancreatic Resections ◽  
Morbidity Index

scholarly journals Pancreatic and duodenal homeobox-1 in pancreatic ductal adenocarcinoma and diabetes mellitus

2020 ◽  
Vol 133 (3) ◽  
pp. 344-350 ◽  
Author(s):  
Zhen-Chu Tang ◽  
Yi Chu ◽  
Yu-Yong Tan ◽  
Jing Li ◽  
Shan Gao
Keyword(s):  
Diabetes Mellitus ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma

scholarly journals Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival

2006 ◽  
Vol 13 (9) ◽  
pp. 1201-1208 ◽  
Author(s):  
Paolo Massucco ◽  
Lorenzo Capussotti ◽  
Antonella Magnino ◽  
Elisa Sperti ◽  
Marco Gatti ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Ductal Adenocarcinoma ◽  
Perioperative Outcome ◽  
Pancreatic Resections

scholarly journals Metformin alters the duodenal microbiome and decreases the incidence of pancreatic ductal adenocarcinoma promoted by diet-induced obesity

2019 ◽  
Vol 317 (6) ◽  
pp. G763-G772 ◽  
Author(s):  
Tien S. Dong ◽  
Hui-Hua Chang ◽  
Meg Hauer ◽  
Venu Lagishetty ◽  
William Katzka ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mouse Model ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma ◽  
Microbial Composition ◽  
Diet Induced Obesity ◽  
Potential Mediator

Pancreatic ductal adenocarcinoma (PDAC)’s growing incidence has been linked to the rise in obesity and type 2 diabetes mellitus. In previous work, we have shown that metformin can prevent the increased incidence of PDAC in a KrasG12D mouse model subjected to a diet high in fat and calories (HFCD). One potential way that metformin can affect the host is through alterations in the gut microbiome. Therefore, we investigated microbial associations with PDAC development and metformin use in the same mouse model. Lox-Stop-Lox Kras G12D/+ (LSL-Kras G12D/+); p48-Cre (KC) mice were given control diet, HFCD, or HFCD with 5 mg/mL metformin in drinking water for 3 mo. At the end of the 3 mo, 16S rRNA sequencing was performed to characterize microbiome composition of duodenal mucosal, duodenal luminal, and cecal luminal samples. KC mice on an HFCD demonstrated depletion of intact acini and formation of advanced pancreatic intraepithelial neoplasia. This effect was completely abrogated by metformin treatment. HFCD was associated with significant changes in microbial composition and diversity in the duodenal mucosa and lumen, much of which was prevented by metformin. In particular, Clostridium sensu stricto was negatively correlated with percent intact acini and seemed to be inhibited by the addition of metformin while on an HFCD. Administration of metformin eliminated PDAC formation in KC mice. This change was associated with significant microbial changes in both the mucosal and luminal microbiome of the duodenum. This suggests that the microbiome may be a potential mediator of the chemopreventive effects of metformin. NEW & NOTEWORTHY Pancreatic ductal adenocarcinoma (PDAC)’s growing incidence has been linked to the rise in obesity and type 2 diabetes mellitus. Administration of metformin eliminated PDAC formation in KC mice with diet-induced obesity. This change was associated with significant microbial changes in both the mucosal and luminal microbiome of the duodenum. This suggests that the microbiome may be a potential mediator of the chemopreventive effects of metformin.

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