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Master Thesis

Impact de la modification des pratiques anesthésiques dans l’anesthésie de la duodéno-pancréatectomie céphalique sur le devenir à court et long terme des patients : une étude rétrospective

Abstract : Background : Cephalic duodénopancréatectomy (DP) is a major abdominal surgical procedure associated with a high incidence of complications. Pancreatic adenocarcinoma (AC), which is associated with a high recurrence rate, is the main etiology leading to DP. Between 2010 and 2014, following the publication of French guidelines for perioperative haemodynamic optimization and for enhanced recovery after surgery (ERAS), perioperative anesthetic management has been modified in our institution. The administration of dexamethasone (DXM), intravenous lidocain (IL), and haemodynamic monitoring with oesophageal Doppler (OD) were reinforced. This study aimed to evaluate the compliance to these guidelines and describe the effect of DXM, IL and OD on short and long term outcomes after DP, especially for patients with AC. Methods : We retrospectively studied all the medical records of patients who underwent DP at the tertiary teaching hospital of Rennes, France, from January 1st 2010 to December 31st 2014. Mortality and, for patients with AC, cancer recurence were assessed until October 1st 2015 and July 1st 2018 for patients who underwent surgery in 2010 and 2014 respectively. Results : Forty-five patients underwent DP in 2010, and 50 in 2014. Population characteristics for both years were not different. Treatment with DXM and/or IL was not associated with a difference in severe perioperative complications or hospital length of stay (LOS). OD monitoring decreased intraoperative volumes of colloid, associated with a trend to a decreased severe perioperative complications rate (p=0,06). There was no effect of OD on LOS. Compliance to guidelines was low, half of 2014 patients receiving DXM and IL, and only 18 % were monitored with OD. 3-year mortality and cancer recurrence were similar whether or not patients received DXM and/or IL, or were monitored with OD. Conclusion : Compliance to guidelines for intraoperative care of patients treated by DP at Rennes teaching hospital was low, especially concerning OD haemodynamic monitoring.
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Master Thesis
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Submitted on : Monday, June 3, 2019 - 2:04:47 PM
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Xavier Losco. Impact de la modification des pratiques anesthésiques dans l’anesthésie de la duodéno-pancréatectomie céphalique sur le devenir à court et long terme des patients : une étude rétrospective. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02145901⟩

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