Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management
Background Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP. Methods This retrospe...
Gespeichert in:
| Veröffentlicht in: | Annals of surgical oncology 2023-11, Vol.30 (12), p.7700-7711 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 7711 |
|---|---|
| container_issue | 12 |
| container_start_page | 7700 |
| container_title | Annals of surgical oncology |
| container_volume | 30 |
| creator | Stoop, Thomas F. von Gohren, André Engstrand, Jennie Sparrelid, Ernesto Gilg, Stefan Del Chiaro, Marco Ghorbani, Poya |
| description | Background
Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP.
Methods
This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC.
Results
The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%;
p
= 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%;
p
= 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142–4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175–0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034–4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772–24.362).
Conclusions
After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed. |
| doi_str_mv | 10.1245/s10434-023-13847-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_647576</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2874649460</sourcerecordid><originalsourceid>FETCH-LOGICAL-c490t-2f032e0439d28f4b5b1e0a6664fd1ceff2953e32826a6936790b3e26dacb5b4e3</originalsourceid><addsrcrecordid>eNp9ks1u1DAUhSMEoqXwAqwssWExAf8nYYNGIzpUKioqLVvL49wMbhN7aieg9tl4OO50RlRlwcrW9XeOj69vUbxm9B3jUr3PjEohS8pFyUQtq_LuSXHIFJakrtlT3FNdlw3X6qB4kfMVpawSVD0vDkSlGi1lfVj8Pvf5mhxbN8aUZ-SLDXYNA4RxRmxoydk0ujgAiR1Z2jwm78h3CHHKZBHDGvLoYyDzboRELuJoe_LVBpfAjoCGw-0HMg_kMrSQtuiA5RaFw6b3zt5Lz-Fm8smHNfk24n02tf4OmZMWE_huT83IMtkWoV2mh4wvi2ed7TO82q9HxeXxp4vF5_L0bHmymJ-WTjZ0LHlHBQfsVdPyupMrtWJArdZadi1z0HW8UQIEr7m2uhG6auhKANetdchKEEdFufPNv2Azrcwm4VvSrYnWm33pGndgtKxUpZH_uOPxZIDWYdRk-0eyxyfB_zDr-NMwqjTnFUOHt3uHFG8mbJ4ZfHbQ9zYAdt_wWolGslooRN_8g17FKQXsB1KV1LKRmiLFd5RLMecE3d80jJrtNJndNBmcJnM_TeYORWL_7s32jyA9WP9H9Qe6_dET</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2874649460</pqid></control><display><type>article</type><title>Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management</title><source>SpringerLink Journals</source><source>SWEPUB Freely available online</source><creator>Stoop, Thomas F. ; von Gohren, André ; Engstrand, Jennie ; Sparrelid, Ernesto ; Gilg, Stefan ; Del Chiaro, Marco ; Ghorbani, Poya</creator><creatorcontrib>Stoop, Thomas F. ; von Gohren, André ; Engstrand, Jennie ; Sparrelid, Ernesto ; Gilg, Stefan ; Del Chiaro, Marco ; Ghorbani, Poya</creatorcontrib><description>Background
Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP.
Methods
This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC.
Results
The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%;
p
= 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%;
p
= 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142–4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175–0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034–4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772–24.362).
Conclusions
After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-023-13847-z</identifier><identifier>PMID: 37596448</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Gastrectomy ; Gastrointestinal surgery ; Medicine ; Medicine & Public Health ; Morbidity ; Mortality ; Oncology ; Pancreatectomy ; Pancreatic Tumors ; Patients ; Risk factors ; Surgery ; Surgical Oncology ; Vigilance</subject><ispartof>Annals of surgical oncology, 2023-11, Vol.30 (12), p.7700-7711</ispartof><rights>The Author(s) 2023</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c490t-2f032e0439d28f4b5b1e0a6664fd1ceff2953e32826a6936790b3e26dacb5b4e3</citedby><cites>FETCH-LOGICAL-c490t-2f032e0439d28f4b5b1e0a6664fd1ceff2953e32826a6936790b3e26dacb5b4e3</cites><orcidid>0000-0003-3328-4516</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-023-13847-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-023-13847-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,776,780,881,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:153536415$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Stoop, Thomas F.</creatorcontrib><creatorcontrib>von Gohren, André</creatorcontrib><creatorcontrib>Engstrand, Jennie</creatorcontrib><creatorcontrib>Sparrelid, Ernesto</creatorcontrib><creatorcontrib>Gilg, Stefan</creatorcontrib><creatorcontrib>Del Chiaro, Marco</creatorcontrib><creatorcontrib>Ghorbani, Poya</creatorcontrib><title>Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><description>Background
Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP.
Methods
This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC.
Results
The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%;
p
= 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%;
p
= 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142–4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175–0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034–4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772–24.362).
Conclusions
After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.</description><subject>Gastrectomy</subject><subject>Gastrointestinal surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Pancreatectomy</subject><subject>Pancreatic Tumors</subject><subject>Patients</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Vigilance</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>D8T</sourceid><recordid>eNp9ks1u1DAUhSMEoqXwAqwssWExAf8nYYNGIzpUKioqLVvL49wMbhN7aieg9tl4OO50RlRlwcrW9XeOj69vUbxm9B3jUr3PjEohS8pFyUQtq_LuSXHIFJakrtlT3FNdlw3X6qB4kfMVpawSVD0vDkSlGi1lfVj8Pvf5mhxbN8aUZ-SLDXYNA4RxRmxoydk0ujgAiR1Z2jwm78h3CHHKZBHDGvLoYyDzboRELuJoe_LVBpfAjoCGw-0HMg_kMrSQtuiA5RaFw6b3zt5Lz-Fm8smHNfk24n02tf4OmZMWE_huT83IMtkWoV2mh4wvi2ed7TO82q9HxeXxp4vF5_L0bHmymJ-WTjZ0LHlHBQfsVdPyupMrtWJArdZadi1z0HW8UQIEr7m2uhG6auhKANetdchKEEdFufPNv2Azrcwm4VvSrYnWm33pGndgtKxUpZH_uOPxZIDWYdRk-0eyxyfB_zDr-NMwqjTnFUOHt3uHFG8mbJ4ZfHbQ9zYAdt_wWolGslooRN_8g17FKQXsB1KV1LKRmiLFd5RLMecE3d80jJrtNJndNBmcJnM_TeYORWL_7s32jyA9WP9H9Qe6_dET</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Stoop, Thomas F.</creator><creator>von Gohren, André</creator><creator>Engstrand, Jennie</creator><creator>Sparrelid, Ernesto</creator><creator>Gilg, Stefan</creator><creator>Del Chiaro, Marco</creator><creator>Ghorbani, Poya</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0003-3328-4516</orcidid></search><sort><creationdate>20231101</creationdate><title>Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management</title><author>Stoop, Thomas F. ; von Gohren, André ; Engstrand, Jennie ; Sparrelid, Ernesto ; Gilg, Stefan ; Del Chiaro, Marco ; Ghorbani, Poya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c490t-2f032e0439d28f4b5b1e0a6664fd1ceff2953e32826a6936790b3e26dacb5b4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Gastrectomy</topic><topic>Gastrointestinal surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Oncology</topic><topic>Pancreatectomy</topic><topic>Pancreatic Tumors</topic><topic>Patients</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Vigilance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stoop, Thomas F.</creatorcontrib><creatorcontrib>von Gohren, André</creatorcontrib><creatorcontrib>Engstrand, Jennie</creatorcontrib><creatorcontrib>Sparrelid, Ernesto</creatorcontrib><creatorcontrib>Gilg, Stefan</creatorcontrib><creatorcontrib>Del Chiaro, Marco</creatorcontrib><creatorcontrib>Ghorbani, Poya</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stoop, Thomas F.</au><au>von Gohren, André</au><au>Engstrand, Jennie</au><au>Sparrelid, Ernesto</au><au>Gilg, Stefan</au><au>Del Chiaro, Marco</au><au>Ghorbani, Poya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><date>2023-11-01</date><risdate>2023</risdate><volume>30</volume><issue>12</issue><spage>7700</spage><epage>7711</epage><pages>7700-7711</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP.
Methods
This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC.
Results
The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%;
p
= 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%;
p
= 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142–4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175–0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034–4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772–24.362).
Conclusions
After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>37596448</pmid><doi>10.1245/s10434-023-13847-z</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-3328-4516</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2023-11, Vol.30 (12), p.7700-7711 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_647576 |
| source | SpringerLink Journals; SWEPUB Freely available online |
| subjects | Gastrectomy Gastrointestinal surgery Medicine Medicine & Public Health Morbidity Mortality Oncology Pancreatectomy Pancreatic Tumors Patients Risk factors Surgery Surgical Oncology Vigilance |
| title | Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T16%3A50%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20Factors,%20Management,%20and%20Outcome%20of%20Gastric%20Venous%20Congestion%20After%20Total%20Pancreatectomy:%20An%20Underestimated%20Complication%20Requiring%20Standardized%20Identification,%20Grading,%20and%20Management&rft.jtitle=Annals%20of%20surgical%20oncology&rft.au=Stoop,%20Thomas%20F.&rft.date=2023-11-01&rft.volume=30&rft.issue=12&rft.spage=7700&rft.epage=7711&rft.pages=7700-7711&rft.issn=1068-9265&rft.eissn=1534-4681&rft_id=info:doi/10.1245/s10434-023-13847-z&rft_dat=%3Cproquest_swepu%3E2874649460%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2874649460&rft_id=info:pmid/37596448&rfr_iscdi=true |