Landmark Publications Pancreas
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Dr. Vidhyachandra Gandhi's review covers acute & chronic pancreatitis, pancreatic cancer, surgical complications, recent findings, and impact on clinical practice. It delves into drainage, prevention of pancreatic fistula, and compares different surgical techniques and outcomes.
Landmark Publications Pancreas
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Presentation Transcript
Landmark PublicationsPancreas Dr Vidhyachandra Gandhi DNB (GI Surgery), DNB (Gen Surgery) MNAMS, FSGE Gastrointestinal & HPB Surgeon Ruby Hall Clinic Pune IHPBA 2018
Period Jan 2017- Jan 2018Indexed JournalsRCT/Reviews/Meta analysis • Acute Pancreatitis • Chronic Pancreatitis • Carcinoma Pancreas • Pancreaticoduodenectomy &Complications • Cystic Neoplasms of Pancreas • Neuroendocrine tumors • Drains India • Journals - Annals of surgery/ Pancreas/ GUT/ Surgery/ NEJM/ BJS/Clinics of North America / Lancet
AP What is known ?
AP New Findings
AP Impact on clinical practice
POPF Grading ISGPF 2005 PCD – grade B or grade C ?
Expensive drug Adverse effects Cost effectiveness - overestimated No significant evidence NEJM trial - several pitfalls
Six RCT Primary outcomes: Postoperative pancreatic-associated morbidity (disease-specific), such as leakage from the pancreatic anastomosis/pancreatic fistula, DGE and biliary leakage Secondary Outcome : survival , blood loss, operative time, duration of hospital stay. QOL
IAP Meeting 2016, JAPAN ANATOMICAL
IAP Meeting 2016, JAPAN Main Concept
BIOLOGICAL CONDITIONAL
ConclusionPancreas – 2017/18 AP – lesser the better CP - Resectional / drainage procedures – equally good Pancreatic fistula (ISGPF) – Biochemical leak, Grade B, Grade C Post PD – Chyle leak defined and graded Classical PD vs PPPD – no difference PJ vs PG – surgeons choice Prevention of pancreatic fistula – long way to go Drains – place them and remove early BRPC – definition changed (anatomical, biochemical and conditional) Non functional PNET – scope for observation
Type 1 – leak from the side branches (parenchymal injuries, pancreatic biopsies, post Splenectomy) Type 2 – leak MPD (disrupted/disconnected duct syndrome) Type 3 – post pancreatectomy