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Background: Delayed gastric emptying (DGE) is a frequent complication after pylorus‐preserving pancreatoduodenectomy. Recent studies have suggested that resection of the pylorus is associated with decreased rates of DGE. However, superiority of pylorus‐resecting pancreatoduodenectomy was not shown in a recent RCT. This meta‐analysis summarized evidence of the effectiveness and safety of pylorus‐preserving compared with pylorus‐resecting pancreatoduodenectomy. Methods: RCTs and non‐randomized studies comparing outcomes of pylorus‐preserving and pylorus‐resecting pancreatoduodenectomy were searched systematically in MEDLINE, Web of Science and CENTRAL. Random‐effects meta‐analyses were performed and the results presented as weighted odds ratios (ORs) or mean differences with their corresponding 95 per cent confidence intervals. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and non‐randomized studies. Results: Three RCTs and eight non‐randomized studies with a total of 992 patients were included. Quantitative synthesis across all studies showed superiority for pylorus‐resecting pancreatoduodenectomy regarding DGE (OR 2·71, 95 per cent c.i. 1·48 to 4·96; P = 0·001) and length of hospital stay (mean difference 3·26 (95 per cent c.i. −1·04 to 5·48) days; P = 0·004). Subgroup analyses including only RCTs showed no significant statistical differences between the two procedures regarding DGE, and for all other effectiveness and safety measures. Conclusion: Pylorus‐resecting pancreatoduodenectomy is not superior to pylorus‐preserving pancreatoduodenectomy for reducing DGE or other relevant complications. [ABSTRACT FROM AUTHOR]

Background Preoperative nutritional status has an impact on patients' clinical outcome. For pancreatic surgery, however, it is unclear which nutritional assessment scores adequately assess malnutrition associated with postoperative outcome. Methods Patients scheduled for elective pancreatic surgery at the University of Heidelberg were screened for eligibility. Twelve nutritional assessment scores were calculated before operation, and patients were categorized as either at risk or not at risk for malnutrition by each score. The postoperative course was monitored prospectively by assessors blinded to the nutritional status. The primary endpoint was major complications evaluated for each score in a multivariable analysis corrected for known risk factors in pancreatic surgery. Results Overall, 279 patients were analysed. A major complication occurred in 61 patients (21·9 per cent). The proportion of malnourished patients differed greatly among the scores, from 1·1 per cent (Nutritional Risk Index) to 79·6 per cent (Nutritional Risk Classification). In the multivariable analysis, only raised amylase level in drainage fluid on postoperative day 1 (odds ratio ( OR) 4·91, 95 per cent c.i. 1·10 to 21·84; P = 0·037) and age ( OR 1·05, 1·02 to 1·09; P = 0·005) were significantly associated with major complications; none of the scores was associated with, or predicted, postoperative complications. Conclusion None of the nutritional assessment scores defined malnutrition relevant to complications after pancreatic surgery and these scores may thus be abandoned. [ABSTRACT FROM AUTHOR]

Background Chyle leak is a well known but poorly characterized complication after pancreatic surgery. Available data on incidence, risk factors and clinical significance of chyle leak are highly heterogeneous. Methods For this cohort study all patients who underwent pancreatic surgery between January 2008 and December 2012 were identified from a prospective database. Chyle leak was defined as any drainage output with triglyceride content of 110 mg/dl or more. Risk factors for chyle leak were assessed by univariable and multivariable analyses. The clinical relevance of chyle leak was evaluated using hospital stay and resolution by 14 days for short-term outcome and overall survival for long-term outcome. Results Chyle leak developed in 346 (10·4 per cent) of 3324 patients. Pre-existing diabetes, resection for malignancy, distal pancreatectomy, duration of surgery 180 min or longer, and concomitant pancreatic fistula or abscess were independent risk factors for chyle leak. Both isolated chyle leak and coincidental chyle leak (with other intra-abdominal complications) were associated with prolonged hospital stay. Some 178 (87·7 per cent) of 203 isolated chyle leaks and 90 (70·3 per cent) of 128 coincidental chyle leaks resolved with conservative management within 14 days. Initial and maximum drainage volumes were associated with duration of hospital stay and success of therapy by 14 days. Impact on survival was restricted to chyle leaks that persisted at 14 days in patients with cancer undergoing palliative surgery. Conclusion Chyle leak is a relevant complication, with an incidence of more than 10 per cent after pancreatic surgery, and has a major impact on hospital stay. Drainage volume is associated with hospital stay and success of therapy. [ABSTRACT FROM AUTHOR]

Background: Liver ischaemia after pancreatic resection is a rare but potentially serious complication. The aim of this study was to determine the impact of postoperative liver ischaemia after pancreatic resection. Methods: All consecutive patients undergoing pancreatic resection between January 2007 and August 2008 in the Department of Surgery in Heidelberg were identified retrospectively from a prospectively collected database and analysed with a focus on postoperative hepatic perfusion failure. Laboratory data, computed tomography (CT) findings, symptoms, therapy and outcome were recorded. Results: A total of 762 patients underwent pancreatic resection in the study period. Seventeen patients (2·2 per cent) with a postoperative increase in liver enzymes underwent contrast-enhanced CT for suspected liver perfusion failure. The types of perfusion failure were hypoperfusion without occlusion of major hepatic vessels (6 patients) and ischaemia with arterial (5) and/or portal vein (6) involvement. The overall mortality rate was 29 per cent (5 of 17 patients). Therapy included conservative treatment (7), radiological or surgical revascularization and necrosectomy or resection of necrotic liver tissue (10). Outcome varied from full recovery (4 patients) to moderate systemic complications (6) and severe complications (7) including death. Simultaneous involvement of the portal vein and hepatic artery was always fatal. Conclusion: Postoperative liver perfusion failure is a rare but potentially severe complication following pancreatic surgery requiring immediate recognition and, if necessary, radiological or surgical intervention. [ABSTRACT FROM AUTHOR]