Long-Term Outcome of Patients with Postoperative Refractory Diarrhea After Tailored Nerve Plexus Dissection Around the Major Visceral Arteries During Pancreatoduodenectomy ... View Full Text


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Article Info

DATE

2022-02-04

AUTHORS

Naomi Kuroki, Yoshihiro Ono, Takafumi Sato, Yosuke Inoue, Atsushi Oba, Hiromichi Ito, Yoshihiro Mise, Akio Saiura, Yu Takahashi

ABSTRACT

BackgroundFor pancreatic ductal adenocarcinoma (PDAC) surgery, extended dissection of the nerve plexus (pl) around the superior mesenteric artery (SMA) or celiac artery (CA) is sometimes necessary. This consequently results in postoperative refractory diarrhea. This study aimed to evaluate the clinical impact of extended nerve plexus dissection around major arteries on postoperative diarrhea.MethodsPatients who underwent pancreatoduodenectomy (PD) for PDAC between January 2013 and December 2016 were included. The frequency of diarrhea (defined as a condition requiring opioid antidiarrheal drug for at least 6 months after surgery) and its short- and long-term outcomes were reviewed.ResultsOf 200 consecutive patients who underwent PD, 78 (39.0%) developed postoperative refractory diarrhea (diarrhea group), and 73 of them (93.6%) underwent hemi-circumferential or more nerve dissection for SMA or CA; both plSMA and plCA dissection were associated with diarrhea. Borderline resectable artery (BR-A) PDAC was included more in the diarrhea group (32.0% vs. 13.1%, P = 0.001); however, the local recurrence rate in the diarrhea group was significantly lower than that in the non-diarrhea group (14.1% vs. 26.2%, P = 0.036). The completion of adjuvant chemotherapy and overall survival were comparable between the two groups. The pre-albumin level improved in 2 years, and 61.3% of patients with diarrhea could stop opioid antidiarrheal drugs within 3 years of surgery.ConclusionsAlthough the frequency of diarrhea increased following nerve plexus dissection around arteries, diarrhea was controllable and resulted in a reduced local recurrence rate. Aggressive dissection of the nerve plexus may be justified for local disease control in BR-A PDAC. More... »

PAGES

1172-1182

References to SciGraph publications

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    http://scigraph.springernature.com/pub.10.1007/s00268-022-06457-5

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35119513


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    24 schema:description BackgroundFor pancreatic ductal adenocarcinoma (PDAC) surgery, extended dissection of the nerve plexus (pl) around the superior mesenteric artery (SMA) or celiac artery (CA) is sometimes necessary. This consequently results in postoperative refractory diarrhea. This study aimed to evaluate the clinical impact of extended nerve plexus dissection around major arteries on postoperative diarrhea.MethodsPatients who underwent pancreatoduodenectomy (PD) for PDAC between January 2013 and December 2016 were included. The frequency of diarrhea (defined as a condition requiring opioid antidiarrheal drug for at least 6 months after surgery) and its short- and long-term outcomes were reviewed.ResultsOf 200 consecutive patients who underwent PD, 78 (39.0%) developed postoperative refractory diarrhea (diarrhea group), and 73 of them (93.6%) underwent hemi-circumferential or more nerve dissection for SMA or CA; both plSMA and plCA dissection were associated with diarrhea. Borderline resectable artery (BR-A) PDAC was included more in the diarrhea group (32.0% vs. 13.1%, P = 0.001); however, the local recurrence rate in the diarrhea group was significantly lower than that in the non-diarrhea group (14.1% vs. 26.2%, P = 0.036). The completion of adjuvant chemotherapy and overall survival were comparable between the two groups. The pre-albumin level improved in 2 years, and 61.3% of patients with diarrhea could stop opioid antidiarrheal drugs within 3 years of surgery.ConclusionsAlthough the frequency of diarrhea increased following nerve plexus dissection around arteries, diarrhea was controllable and resulted in a reduced local recurrence rate. Aggressive dissection of the nerve plexus may be justified for local disease control in BR-A PDAC.
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    33 adjuvant chemotherapy
    34 aggressive dissection
    35 antidiarrheal drugs
    36 artery
    37 cancer
    38 celiac artery
    39 chemotherapy
    40 clinical impact
    41 completion
    42 consecutive patients
    43 control
    44 diarrhea
    45 diarrhea group
    46 disease control
    47 dissection
    48 drugs
    49 extended dissection
    50 frequency
    51 frequency of diarrhea
    52 group
    53 impact
    54 levels
    55 local disease control
    56 local recurrence rate
    57 long-term outcomes
    58 major arteries
    59 major visceral arteries
    60 mesenteric artery
    61 nerve dissection
    62 nerve plexus
    63 non-diarrhea group
    64 outcomes
    65 overall survival
    66 pancreatic cancer
    67 pancreatoduodenectomy
    68 patients
    69 plexus
    70 postoperative diarrhea
    71 pre-albumin levels
    72 rate
    73 recurrence rate
    74 refractory diarrhea
    75 study
    76 superior mesenteric artery
    77 surgery
    78 survival
    79 term outcomes
    80 visceral arteries
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    82 years
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