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Master Thesis

Complications postopératoires après exploration chirurgicale dans un but curatif, pour cancers péri ampullaires, sans possibilité de résection tumorale : étude multicentrique sur 134 cas

Abstract : Background: A significant part of patients, initially planned for Duodenopancreatectomy (PD), are not resected due to oncology contraindications. After preoperative staging, surgical exploration remains the only way to determine the relevance of pancreatic resection, especially when neoadjuvant therapy is performed. Extensive perivascular dissection could be performed with potentially postoperative morbi-mortality which remains unknown. The aim of this study was to report the complications after surgical staging and to studied the postoperative impact of an extensive dissection. Methods: In this multicenter study, all patients planned for DP in an oncological context, between January 1st, 2010 and December 31st, 2019, were retrospectively collected. We compared the outcomes for the patients with and without extensive perivascular dissection during the surgical exploration and described serious adverse events in this population. Results: Among 774 patients in total, 134 were recused for curative pancreatic resection and surgical resection rate was 82.7%. Patients with extensive perivascular dissection were 34 (25.3%) with significantly more postoperative sepsis (OR=7.945; p=0.02) and bleeding (OR=17.35 ; p=0.03). In our study, the patients recused for curative surgery had major complications (Dindo-Clavien 3) in 17.9%, 6% had postoperative bleeding and 90-days mortality was 3%. 75% of deaths were associated with bleeding in our series. Conclusion: Even if patients are recused for pancreatic resection during surgical staging for periampullary carcinoma, they are exposed to adverse events potentially due to extensive perivascular dissection. The increase use of neoadjuvant therapy with the difficulty to establish preoperatively the possibility of curative surgery lead to more surgical exploration with extensive dissection. This study highlights an increased risk of postoperative complications in patients with extensive surgical staging.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02976111
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Submitted on : Friday, October 23, 2020 - 11:57:21 AM
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  • HAL Id : dumas-02976111, version 1

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Quentin Chenevas-Paule. Complications postopératoires après exploration chirurgicale dans un but curatif, pour cancers péri ampullaires, sans possibilité de résection tumorale : étude multicentrique sur 134 cas. Médecine humaine et pathologie. 2020. ⟨dumas-02976111⟩

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