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Postoperative Management in Patients Undergoing Major Pancreatic Resections

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Abstract

Perioperative care following pancreatectomy in “high-volume” center is based on the application of standardized protocols. The clinical practice includes multimodal strategies that aim to limit postoperative complications, to improve recovery, and to reduce the length of hospital stay after surgery. This chapter discusses the perioperative care of patients undergoing pancreatic resections focusing on major topics such as fluid management, antimicrobial prophylaxis, feeding, drain management, administration of prophylactic somatostatin or its analogues, and radiological findings following surgery.

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References

  1. Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95(3):357–62.

    Article  CAS  PubMed  Google Scholar 

  2. Pratt WB, Callery MP, Vollmer CM. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg. 2008;32(3):419–28.

    Article  PubMed  Google Scholar 

  3. Lassen K, Coolsen MME, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31(6):817–30.

    Article  PubMed  Google Scholar 

  4. Futier E, Constantin J-M, Petit A, Chanques G, Kwiatkowski F, Flamein R, et al. Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: a prospective randomized trial. Arch Surg. 2010;145(12):1193–200.

    Article  PubMed  Google Scholar 

  5. Lavu H, Sell NM, Carter TI, Winter JM, Maguire DP, Gratch DM, et al. The HYSLAR trial. Ann Surg. 2014;260(3):445–55.

    Article  PubMed  Google Scholar 

  6. Fischer M, Matsuo K, Gonen M, Grant F, Dematteo RP, D’Angelica MI, et al. Relationship between intraoperative fluid administration and perioperative outcome after pancreaticoduodenectomy: results of a prospective randomized trial of acute normovolemic hemodilution compared with standard intraoperative management. Ann Surg. 2010;252(6):952–8.

    Article  PubMed  Google Scholar 

  7. Qureshi SH, Rizvi SI, Patel NN, Murphy GJ. Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients. Br J Surg. 2016;103(1):14–26.

    Article  CAS  PubMed  Google Scholar 

  8. Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg. 2012;255(5):821–9.

    Article  PubMed  Google Scholar 

  9. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 26(1 Suppl):1SA–138SA.

    Google Scholar 

  10. Gerritsen A, Besselink MGH, Gouma DJ, Steenhagen E, Borel Rinkes IHM, Molenaar IQ. Systematic review of five feeding routes after pancreatoduodenectomy. Br J Surg. 2013;100(5):589–98. discussion 599

    Article  CAS  PubMed  Google Scholar 

  11. Myers JG, Page CP, Stewart RM, Schwesinger WH, Sirinek KR, Aust JB. Complications of needle catheter jejunostomy in 2,022 consecutive applications. Am J Surg. 1995;170(6):547. -50-1

    Article  CAS  PubMed  Google Scholar 

  12. O’Keefe SJD, Lee RB, Anderson FP, Gennings C, Abou-Assi S, Clore J, et al. Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans. Am J Physiol Gastrointest Liver Physiol. 2003;284(1):G27–36.

    Article  PubMed  Google Scholar 

  13. Bassi C, Malleo G. Pancreas: postoperative pancreatic fistula: use of enteral nutrition. Nat Rev Gastroenterol Hepatol. 2011;8(8):427–8.

    Article  CAS  PubMed  Google Scholar 

  14. O’Keefe SJD. Physiological response of the human pancreas to enteral and parenteral feeding. Curr Opin Clin Nutr Metab Care. 2006;9(5):622–8.

    Article  PubMed  Google Scholar 

  15. Xiong JJ, Altaf K, Mukherjee R, Huang W, Hu WM, Li A, et al. Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy. Br J Surg. 2012;99(8):1050–61.

    Article  CAS  PubMed  Google Scholar 

  16. Klek S, Sierzega M, Turczynowski L, Szybinski P, Szczepanek K, Kulig J. Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial. Gastroenterology. 2011;141(1):157–63, 163.e1

    Article  PubMed  Google Scholar 

  17. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg. 1992;216(2):172–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gianotti L, Braga M, Gentilini O, Balzano G, Zerbi A, Di Carlo V. Artificial nutrition after pancreaticoduodenectomy. Pancreas. 2000;21(4):344–51.

    Article  CAS  PubMed  Google Scholar 

  19. Nelson Richard L, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev. 2014;5:CD001181.

    Google Scholar 

  20. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006;43:322–30.

    Article  PubMed  Google Scholar 

  21. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630–41.

    Article  PubMed  Google Scholar 

  22. Povoski SP, Karpeh MS, Conlon KC, Blumgart LH, Brennan MF. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg. 1999;230(2):131–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kondo K, Chijiiwa K, Ohuchida J, Kai M, Fujii Y, Otani K, et al. Selection of prophylactic antibiotics according to the microorganisms isolated from surgical site infections (SSIs) in a previous series of surgeries reduces SSI incidence after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2013;20(3):286–93.

    Article  PubMed  Google Scholar 

  24. Fong ZV, McMillan MT, Marchegiani G, Sahora K, Malleo G, De Pastena M, et al. Discordance between perioperative antibiotic prophylaxis and wound infection cultures in patients undergoing pancreaticoduodenectomy. JAMA Surg. 2015;2114:1–8.

    Google Scholar 

  25. Sudo T, Murakami Y, Uemura K, Hayashidani Y, Hashimoto Y, Ohge H, et al. Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage. World J Surg. 2007;31(11):2230–5.

    Article  PubMed  Google Scholar 

  26. Donald GW, Sunjaya D, Lu X, Chen F, Clerkin B, Eibl G, et al. Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage? Surgery. 2013;154(2):190–6.

    Article  PubMed  Google Scholar 

  27. Sourrouille I, Gaujoux S, Lacave G, Bert F, Dokmak S, Belghiti J, et al. Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination. HPB. 2013;15(6):473–80.

    Article  PubMed  Google Scholar 

  28. Samama CM, Geerts W-H. Prevention of intraoperative venous thromboembolism: what are the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition)? Ann Fr Anesth Reanim. 2009;28(9 Suppl):S23–8.

    Article  CAS  PubMed  Google Scholar 

  29. Sweetland S, Green J, Liu B, Berrington de González A, Canonico M, Reeves G, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ. 2009;339:b4583.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mandalà M, Falanga A, Roila F, ESMO Guidelines Working Group. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol Off J Eur Soc Med Oncol. 2011;22 Suppl 6(3):vi85–92.

    Google Scholar 

  31. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 SUPPL):227–77.

    Article  CAS  Google Scholar 

  32. Harris AG. Somatostatin and somatostatin analogues: pharmacokinetics and pharmacodynamic effects. Gut. 1994;35:S1–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Allen PJ, Gönen M, Brennan MF, Bucknor AA, Robinson LM, Pappas MM, et al. Pasireotide for postoperative pancreatic fistula. N Engl J Med. 2014;370(21):2014–22.

    Article  CAS  PubMed  Google Scholar 

  34. McMillan MT, Christein JD, Callery MP, Behrman SW, Drebin JA, Kent TS, et al. Prophylactic octreotide for pancreatoduodenectomy: more harm than good? HPB (Oxford). 2014;16(10):954–62.

    Article  Google Scholar 

  35. Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev. 2013;(4):CD008370.

    Google Scholar 

  36. Fiore JF, Castelino T, Pecorelli N, Niculiseanu P, Balvardi S, Hershorn O, et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery. Ann Surg. 2017;266(2):223–31.

    Article  PubMed  Google Scholar 

  37. Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg. 2001;234(4):487–93; discussion 493-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg. 2010;252(2):207–14.

    Article  PubMed  Google Scholar 

  39. Van Buren G, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg. 2014;259(4):605–12.

    Article  PubMed  Google Scholar 

  40. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.

    Article  PubMed  Google Scholar 

  41. McMillan MT, Fisher WE, Van Buren G, McElhany A, Bloomston M, Hughes SJ, et al. The value of drains as a fistula mitigation strategy for pancreatoduodenectomy: something for everyone? Results of a randomized prospective multi-institutional study. J Gastrointest Surg. 2015;19(1):21–31.

    Article  PubMed  Google Scholar 

  42. McMillan MT, Malleo G, Bassi C, Allegrini V, Casetti L, Drebin JA, et al. Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg. 2017;265(6):1209–18.

    Article  PubMed  Google Scholar 

  43. Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg. 2007;246(2):281–7.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Fong ZV, Correa-Gallego C, Ferrone CR, Veillette GR, Warshaw AL, Lillemoe KD, et al. Early drain removal-the middle ground between the drain versus no drain debate in patients undergoing pancreaticoduodenectomy: a prospective validation study. Ann Surg. 2015;262(2):378–83.

    Article  Google Scholar 

  45. Partelli S, Tamburrino D, Crippa S, Facci E, Zardini C, Falconi M. Evaluation of a predictive model for pancreatic fistula based on amylase value in drains after pancreatic resection. Am J Surg. 2014;208(4):634–9.

    Article  PubMed  Google Scholar 

  46. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.

    Article  PubMed  Google Scholar 

  47. Malleo G, Salvia R, Butturini G, D’Onofrio M, Martone E, Marchegiani G, et al. Is routine imaging necessary after pancreatic resection? An appraisal of postoperative ultrasonography for the detection of pancreatic fistula. Pancreas. 2014;43(2):319–23.

    Article  PubMed  Google Scholar 

  48. Bruno O, Brancatelli G, Sauvanet A, Vullierme MP, Barrau V, Vilgrain V. Utility of CT in the diagnosis of pancreatic fistula after pancreaticoduodenectomy in patients with soft pancreas. AJR Am J Roentgenol. 2009;193(3):W175–80.

    Article  PubMed  Google Scholar 

  49. Sierzega M, Kulig P, Kolodziejczyk P, Kulig J. Natural history of intra-abdominal fluid collections following pancreatic surgery. J Gastrointest Surg. 2013;17(8):1406–13.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Gervais DA, Fernandez-del Castillo C, O’Neill MJ, Hahn PF, Mueller PR. Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures. Radiographics. 2001;21:673–90.

    Article  CAS  PubMed  Google Scholar 

  51. Faccioli N, Foti G, Molinari E, Hermans JJ, Comai A, Talamini G, et al. Role of fistulography in evaluating pancreatic fistula after pancreaticoduodenectomy. Br J Radiol. 2012;85(1011):219–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Mcmillan MT, Malleo G, Bassi C, Butturini G, Salvia R, Roses RE, et al. Drain management after pancreatoduodenectomy: reappraisal of a prospective randomized trial using risk stratification. J Am Coll Surg. 2015;221(4):798–809.

    Article  PubMed  Google Scholar 

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Correspondence to Claudio Bassi .

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Pulvirenti, A., Pea, A., De Pastena, M., Marchegiani, G., Salvia, R., Bassi, C. (2018). Postoperative Management in Patients Undergoing Major Pancreatic Resections. In: Tewari, M. (eds) Surgery for Pancreatic and Periampullary Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-7464-6_25

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  • DOI: https://doi.org/10.1007/978-981-10-7464-6_25

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