Landmark Publications Pancreas Dr Vidhyachandra Gandhi DNB GI
Landmark Publications Pancreas Dr Vidhyachandra Gandhi DNB (GI Surgery), DNB (Gen Surgery) MNAMS, FSGE Gastrointestinal & HPB Surgeon Ruby Hall Clinic Pune IHPBA 2018
Period Jan 2017 - Jan 2018 Indexed Journals RCT/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
Acute Pancreatitis
AP
What is known ? AP
New Findings AP
AP Impact on clinical practice
Chronic Pancreatitis
CP
Post Operative Pancreatic Fistula
POPF Grading ISGPF 2005 PCD – grade B or grade C ?
Pharmacological Prevention of Pancreatic Fistula
Expensive drug Adverse effects Cost effectiveness - overestimated No significant evidence NEJM trial - several pitfalls
TO DRAIN OR NOT
PPPD vs Classical PD which is better ?
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
PJ vs PG which is better ?
Chyle Leak
Borderline Resectable Pancreatic Cancer
IAP Meeting 2016, JAPAN ANATOMICAL
ANATOMICAL
IAP Meeting 2016, JAPAN Main Concept
BIOLOGICAL CONDITIONAL
NOMENCLATURE
INDIA
Pancreatic Neuroendocrine Tumors
Conclusion Pancreas – 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, Type 2 – leak MPD (disrupted/disconnected duct syndrome) Type 3 – post pancreatectomy post Splenectomy)
- Slides: 43