Publications by authors named "Yi-Ming Shyr"
Background: Mesopancreas dissection (MPD) level 3 in combined robotic/open pancreatoduodenectomy (CR/OPD) is technique-demanding. This study aims to clarify the feasibility and justification of MPD level 3.
Methods: Propensity score matching (PSM) analysis was conducted for 208 patients with pancreatic head cancer undergoing CR/OPD with or without MPD level 3.
Background: The aim of this study is to assess the impact of obesity on the perioperative outcomes in robotic pancreaticoduodenectomy (RPD), rarely documented.
Methods: A total of 886 patients undergoing RPD or open pancreaticoduodenectomy (OPD) were enroled. These patients were categorised into the obese RPD, non-obese RPD and obese OPD groups.
Importance: Postoperative pancreatic fistulas (POPF) are the biggest contributor to surgical morbidity and mortality after pancreatoduodenectomy. The impact of POPF could be influenced by the surgical approach.
Objective: To assess the clinical impact of POPF in patients undergoing minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD).
Background: Pancreatoduodenectomy in elderly patients may be associated with increased postoperative mortality, but studies in minimally invasive pancreatoduodenectomy (MIPD) are scarce.
Methods: International multicenter retrospective study including patients aged >60 years undergoing MIPD (robot-assisted and laparoscopic) and open pancreatoduodenectomy (OPD), were categorized by age: 60-69, 70-79, and 80+ years. In each category, propensity score matching (PSM) was performed (1:1 ratio) between MIPD and OPD.
Article Synopsis
- Metastatic melanoma of the ampulla of Vater is a rare condition with 14 patient cases analyzed, primarily from cutaneous origins (73%) and presenting with jaundice (86% as a common symptom).
- The median size of the melanoma was 2.75 cm, and most patients (82%) had metastasis to other organs like the brain, lungs, and liver at diagnosis.
- Surgical interventions like pancreaticoduodenectomy, along with chemotherapy, were linked to improved survival rates, highlighting that major surgeries can still be viable options even in metastatic cases.
Article Synopsis
- Robotic pancreatoduodenectomy is gaining popularity globally, with positive outcomes reported, but more large-scale studies are needed to assess the impact of the learning curve on these results.* -
- An extensive study was conducted involving 2,186 patients from 18 centers in 8 countries, analyzing the learning curve and its effects on feasibility (operative time and blood loss) and proficiency (complications and morbidity).* -
- Findings revealed that a significant reduction in major morbidity occurred after 90 procedures, with improved outcomes across the board, while mortality rates remained steady throughout different experience levels among centers.*
Background: Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection.
Methods: From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed.
Article Synopsis
- The study examined the feasibility and safety of robotic pancreatoduodenectomy (RPD) for patients with hepatic artery variation (HAV) compared to traditional open surgery.
- The incidence of HAV was found to be 16%, with slight differences in vascular injury rates between RPD and open procedures, but overall no increased surgical complications.
- The results indicated that HAV does not adversely affect surgical, oncological, or survival outcomes in patients undergoing RPD, provided that it is correctly identified and managed during surgery.
Background: Duodenal adenocarcinoma is rare and its prognostic factors remain controversial. In our study, the role of cell-free deoxyribonucleic acid (cfDNA) as prognostic factor in duodenal adenocarcinoma was evaluated.
Methods: From June 2003 to July 2021, plasma samples were collected from 41 patients with duodenal adenocarcinoma.
International consensus guidelines on robotic pancreatic surgery in 2023.
Hepatobiliary Surg Nutr
February 2024
Background: With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS.
View Article and Find Full Text PDFBackground/objective: Robotic pancreaticoduodenectomy in ampullary cancer has never been studied. This study aimed to clarify the feasibility and justification of robotic pancreaticoduodenectomy in ampullary cancer in terms of surgical risks, and oncologic and survival outcomes.
Methods: A propensity score-matching comparison of robotic and open pancreaticoduodenectomy based on seven factors commonly used to predict the survival outcomes in ampullary cancer patients.
Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy.
J Hepatobiliary Pancreat Sci
February 2024
Article Synopsis
- A study analyzed the outcomes of robotic pancreaticoduodenectomy (RPD) by comparing results from two groups of 500 patients—early (first 250) and late (last 250)—to assess feasibility and surgical risks over time.
- The late group showed a significantly lower conversion rate (5.6%) compared to the early group (12.0%), and overall surgical complications and mortality rates were relatively low and similar between both groups.
- The findings suggest that RPD is technically feasible and justified, providing good oncological outcomes with benefits of low blood loss and surgical mortality, particularly for ampullary adenocarcinoma patients.
Aim: Whether to execute pancreaticoduodenectomy or not for older people could pose a dilemma. This study clarifies the safety and justification of robotic pancreaticoduodenectomy (RPD) for older individuals over 80.
Methods: A total of 500 patients undergoing RPD were divided into group O (≥ 80 y/o) and group Y (< 80 y/o) for comparison.
Article Synopsis
- * In a study comparing RCP to open central pancreatectomy (OCP), RCP had a shorter operation time (4.2 hours vs. 5.5 hours) and significantly less blood loss (20 c.c. vs. 170 c.c.).
- * Postoperative complications were similar for both procedures, with RCP showing a slightly higher rate of pancreatic fistulas (22.1%) compared to OCP (15.4%), but overall, RCP is considered a feasible and safe option.
Background: Cell-free DNA (cfDNA) as an oncological biomarker has drawn much attention in recent years, but very limited effort has been made to investigate the prognostic values of cfDNA in distal common bile duct (CBD) cancer.
Methods: Plasma cfDNA was measured in 67 patients with resectable distal CBD cancer. Survival outcomes and the correlation of cfDNA with other conventional prognostic factors were determined.
The study of robotic pancreaticouodenectomy (RPD) focusing on delayed gastric emptying (DGE) is seldom reported. This study explored the incidence of DGE in RPD with extracorporeal hand-sewn gastrojejunostomy involving downward positioning of the stomach. Patients with periampullary lesions undergoing RPD or open pancreaticouodenectomy (OPD) were included for comparison.
View Article and Find Full Text PDFBackground And Aims: There is no consensus on the superiority of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP).
Methods: Data of patients undergoing RDP and LDP were prospectively collected and compared.
Results: There were 65 RDP and 112 LDP.
Article Synopsis
- This study explored the feasibility of pancreatic head sparing (PHS) enucleation for patients with agenesis of the dorsal pancreas (ADP) who have solid pseudopapillary tumors (SPT).
- Researchers compared data from 31 SPT patients, noting surgical outcomes and survival rates for those with and without ADP.
- The results indicated that PHS enucleation is a viable option, as it showed similar surgical complications, and no recurring tumors in ADP patients, while overall survival rates were strong at 5, 10, 20, and 25 years.
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is highly aggressive and has poor prognosis. There are few biomarkers to inform treatment decisions, and collecting tumour samples for testing is challenging.
Methods: Circulating tumour cells (CTCs) from patients with PDAC liquid biopsies were expanded ex vivo to form CTC-derived organoid cultures, using a laboratory-developed biomimetic cell culture system.
Background/objective: Pancreatic neuroendocrine tumors (P-NETs) are highly heterogeneous with wide spectrum of biological behaviors and growth patterns. Here, we aimed to assess the impact of tumor grading on P-NETs prognosis and survival outcomes.
Methods: Patients with P-NET were recruited to determine correlations between grades and clinicopathological factors, survival outcomes and prognostic factors.
Background: Whether epidural anesthesia and analgesia (EA) improves long-term outcomes after pancreatic cancer surgery remains controversial. We conducted this retrospective cohort study to investigate the influence of EA on cancer recurrence and overall survival after surgery for pancreatic cancer.
Methods: We conducted an electronic medical chart review of patients with pancreatic cancer who underwent curative resection at our hospital from 2008 to 2017 and were followed up until December 2019.
Theoretically, pancreas transplant alone in uremic (PTAU) patients could also be one of the options for those waiting for both pancreas and kidney grafts, but it has never been reported. There were 160 cases of pancreas transplant in this study, including 16% PTAU. The 5-year patient survival was 66.
View Article and Find Full Text PDFRobotic pancreaticoduodenectomy for pancreatic head cancer and periampullary lesions.
Ann Gastroenterol Surg
September 2021
Pancreaticoduodenectomy, so-called "Whipple operation," is a time-consuming and technically demanding complex operation. Traditionally, this procedure has been performed most usually by open approach, which results in a large and painful wound. With the introduction of laparoscopic and robotic surgery, minimally invasive surgery (MIS) has emerged as a worldwide trend to improve wound cosmesis and to minimize wound pain.
View Article and Find Full Text PDFA comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus.
Hepatobiliary Surg Nutr
August 2021
Background: Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus (DM). It is widely accepted as an optimal procedure for type 1 DM (T1DM), but its application in type 2 DM (T2DM) is not unanimously acknowledged.
Methods: In total, 146 diabetes patients undergoing pancreas transplantation were included in this study.