Survival benefit associated with screening of patients at elevated risk for pancreatic cancer.

Unlabelled: BACKGROUND & OBJECTIVES: Screening for pancreatic cancer is recommended for individuals with a strong family history, certain genetic syndromes, or a neoplastic cyst of the pancreas. However, limited data supports a survival benefit attributable to screening these higher-risk individuals.

Methods: All patients enrolled in screening at a High-Risk Pancreatic Cancer Clinic (HRC) from July 2013 to June 2020 were identified from a prospectively maintained institutional database and compared to patients evaluated at a Surgical Oncology Clinic (SOC) at the same institution during the same period.

Americas Hepato-Pancreato-Biliary Association HPB Ultrasound and Advanced Technology post-graduate course: Overview and review.

Background: Americas Hepato-Pancreato-Biliary Association (AHPBA) established the Hepato-Pancreato-Biliary (HPB) ultrasound (US) and Advanced Technology Post-Graduate Course in 2012 in response to a perceived gap in training and practice.

Methods: The HPB US and Advanced Technology Post-Graduate Course consists of both didactic and hands-on skills sessions. The didactic sessions are divided into foundational, organ-focused, and application content.

Ultrasound scanning techniques.

Background: Ultrasound is an essential tool for the hepatobiliary and pancreatic surgeon.

Methods: This review focuses on transabdominal, open intraoperative, and laparoscopic ultrasonography of the liver, biliary tract, and pancreas. The goal is to obtain optimal ultrasound images through an understanding of the equipment setup, transducer (probe) selection, terminology, and general scanning principles.

Efficacy of opioid spinal analgesia for postoperative pain management after pancreatoduodenectomy.

Background: Efficacy of single-shot opioid spinal analgesia after pancreatoduodenectomy remains understudied and lacks comparison to standard continuous thoracic epidural analgesia (TEA).

Methods: Pancreatoduodenectomy patients who underwent TEA or opioid spinal for postoperative pain management from 2015 to 2020 were included in this observational cohort study. Primary outcome was patient-reported mean daily pain scores.

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations.

Objective: Our objective was to examine the associations between early discharge and readmission after major abdominal operations.

Background: Advances in patient care resulted in earlier patient discharge after complex abdominal operations. Whether early discharge is associated with patient readmissions remains controversial.

The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection.

Background: Independent associations between chronic liver disease, MELD, and postoperative outcomes among patients selected for liver resection have not been completely established. We hypothesized independent associations between MELD, cirrhosis, and postoperative mortality.

Methods: Patient-level data from the targeted hepatectomy module and ACS NSQIP PUF during 2014-2015 were merged.

Efficacy of Radiofrequency Ablation Transarterial Chemoembolization for Patients with Solitary Hepatocellular Carcinoma ≤3 cm.

Optimal treatment for small hepatocellular carcinoma (HCC) ≤ 3 cm remains controversial. Ablation and chemoembolization are considered for nonoperative candidates. This study compares survival among patients with solitary HCC ≤ 3 cm treated with radiofrequency ablation (RFA) and transarterial chemoembolization (TACE).

Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death.

Background: Safety of pancreaticoduodenectomy has improved significantly in the past 3 decades. Current inpatient and 30-d mortality rates are low. However, incidence and causes of 90-d and 1-y mortality are poorly defined and largely unexplored.

Pancreatic duct size and gland texture are associated with pancreatic fistula after pancreaticoduodenectomy but not after distal pancreatectomy.

Background: Pancreatic fistula remains a morbid complication after pancreatectomy. Since the proposed mechanism of pancreatic fistula is different between pancreaticoduodenectomy and distal pancreatectomy, we hypothesized that pancreatic gland texture and duct size are not associated with pancreatic fistula after distal pancreatectomy.

Methods: All patients ≥18 years in the 2014-15 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset were linked with the ACS NSQIP Public Use File (PUF).

A Method for Functional Task Alignment Analysis of an Arthrocentesis Simulator.

Introduction: During simulation-based education, simulators are subjected to procedures composed of a variety of tasks and processes. Simulators should functionally represent a patient in response to the physical action of these tasks. The aim of this work was to describe a method for determining whether a simulator does or does not have sufficient functional task alignment (FTA) to be used in a simulation.

Molecular analysis of pancreatic cyst fluid changes clinical management.

Background And Objectives: DNA molecular analysis has been suggested as a tool to evaluate pancreatic cysts. This study assesses whether the addition of DNA molecular analysis alters clinical management.

Methods: This is a retrospective review of 46 consecutive patients who underwent EUS-FNA of pancreatic cysts with DNA molecular analysis at two major academic institutions.

Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection.

Background: Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality.

Methods: Adult patients in the 2014-2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset.

Comparative Effectiveness of Resection vs Surveillance for Pancreatic Branch Duct Intraductal Papillary Mucinous Neoplasms With Worrisome Features.

Importance: The 2012 international consensus guidelines defined a subcategory of pancreatic branch duct intraductal papillary mucinous neoplasms with “worrisome features,” which may be followed with close surveillance. However, given the poor prognosis of invasive malignancy, the role of early, upfront resection requires further investigation.

Objective: To compare the utility of upfront resection vs long-term surveillance.

Operative management of chronic pancreatitis: A review.

Background: Pain secondary to chronic pancreatitis is a difficult clinical problem to manage. Many patients are treated medically or undergo endoscopic therapy and surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach.

Results: There have been a number of advances in the operative management of chronic pancreatitis over the last few decades and current therapies include drainage procedures (pancreaticojejunostomy, etc.

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy.

Background: Previous studies have indicated that blood transfusion is associated with increased risk of worse outcomes among patients selected for hepatectomy. However, the independent effect of transfusion has not been confirmed. We hypothesize that blood transfusion is an independent factor that affects outcomes in patients undergoing hepatectomy.

The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention.

Objective: The purpose of this study was to determine whether bacterial contamination of islets affects graft success after total pancreatectomy with islet autotransplantation (TPIAT).

Background: Factors associated with insulin independence after TPIAT are inconclusive. Although bacterial contamination does not preclude transplantation, the impact of bacterial contamination on graft success is unknown.

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors.

Background: Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy.

The impact of chronic liver disease on the risk assessment of ACS NSQIP morbidity and mortality after hepatic resection.

Background: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk-adjustment model for patients who require hepatic resection does not include metrics of underlying chronic liver disease. The applicability of the current risk adjustment model is under debate. This study aims to assess the impact of chronic liver disease on the ACS NSQIP estimates of postoperative morbidity and mortality.

Impact of Postoperative Venous Thromboembolism on Postoperative Morbidity, Mortality, and Resource Utilization after Hepatectomy.

The impact of venous thromboembolism (VTE) after hepatectomy on patient morbidity, mortality, and resource usage remains poorly defined. Better understanding of thromboembolic complications is needed to improve perioperative management and overall outcomes. About 3973 patients underwent hepatectomy within NSQIP between 2005 and 2008.

A Long Gastrojejunostomy Is Associated With Decreased Incidence and Severity of Delayed Gastric Emptying After Pancreaticoduodenectomy.

Objectives: Delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) is associated with increased hospital length of stay (LOS) and health care costs. We hypothesized that a long gastrojejunostomy for PD (LGPD) is associated with decreased incidence of DGE.

Methods: Data were reviewed from patients who underwent standard PD (SPD), pylorus-preserving PD (PPPD), or LGPD with a 9-cm-long anastomosis between August 2000 and July 2010.

Improving treatment and survival: a population-based study of current outcomes after a hepatic resection in patients with metastatic colorectal cancer.

Background: Population-based studies historically report underutilization of a resection in patients with colorectal metastases to the liver. Recent data suggest limitations of the methods in the historical analysis. The present study examines trends in a hepatic resection and survival among Medicare recipients with hepatic metastases.

Morbidity and mortality of hepatectomy for benign liver tumors.

Background: This study compared the morbidity and mortality following hepatectomy for benign liver tumors and hepatic metastases.

Methods: This retrospective cohort study compared patients who underwent hepatectomy for benign liver tumors and metastases reported to National Surgical Quality Improvement Program between 2005 and 2011.

Results: A total of 5,542 patients underwent hepatectomy: 1,164 (21%) for benign and 4,378 (79%) for metastatic diseases.

IgG4-Associated Cholangitis Can Mimic Hilar Cholangiocarcinoma.

IgG4-associated cholangitis can mimic hilar cholangiocarcinoma. Previously reported patients with IgG4-associated cholangitis mimicking cholangiocarcinoma had elevated serum IgG4 levels and long-segment biliary strictures. However, in the absence of other diagnostic criteria for malignancy, IgG4-associated cholangitis should remain a consideration among patients with normal serum IgG4 and a hilar mass suspicious for cholangiocarcinoma.