Pancreaticoduodenectomy following liver transplantation: Operative technique and outcomes
Orthotopic liver transplant (OLT) remains the only viable treatment strategy for patients with end stage liver disease. Since the first successful OLT in 1963, survival has significantly improved, reaching approximately 80% at 3 years, which leaves patients at risk of developing secondary malignanci...
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Published in: | The American journal of surgery 2024-05, Vol.231, p.142-145 |
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Main Authors: | , , |
Format: | Article |
Language: | English |
Subjects: | |
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Online Access: | Get full text |
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Summary: | Orthotopic liver transplant (OLT) remains the only viable treatment strategy for patients with end stage liver disease. Since the first successful OLT in 1963, survival has significantly improved, reaching approximately 80% at 3 years, which leaves patients at risk of developing secondary malignancies or age-related diagnoses requiring surgical intervention.1 Abdominal operations, particularly those involving the pancreatic head and biliary tree such as pancreaticoduodenectomy, following OLT present significant technical challenges given the anatomic changes and profound adhesive disease following the thorough dissection of OLT. [...]some patients following OLT are maintained on steroids, which can be associated with surgical challenges in addition to their immunosuppressive effects, including visceral adiposity, central obesity, or steroid-induced diabetes with perioperative hyperglycemia. Sex Age at OLT (y) OLT Indication MELD at OLT Age at PD (y) Indication for PD Interval between OLT to PD Prior abdominal operations Follow-up (Mo) PD OR Time (Min) PD EBL (cc) PD Pathology PD Perioperative complications (30d) PD Readmission (30d) 1 M 58 PSC 28 58 IPMN 3 days Total abdominal colectomy 12 212 200 Low-grade biliary intraepithelial neoplasia None None 2 M 69 HCC 13 74 Distal cholangio-carcinoma 5 years N/A 4 242 60 Invasive adenocarcinoma, poorly differentiated, LVI/NVI Intraabdominal fluid collection, atrial fibrillation None 3 F 44 Sickle cell hepatopathy 26 44 Large pseudoaneurysm 171 days N/A 6 252 100 Benign None None 4 M 58 A1AT 16 59 IPMN 441 days Open aborted cholecystectomy 25 202 400 IPMN with microinvasive adenocarcinoma Pancraetico-cutaneous fistula Yes, wound management 5 M 37 PSC 6 37 High-grade dysplasia in distal CBD 9 days Total abdominal colectomy w/J-pouch 156 177 200 High grade dysplasia, CBD strictures Postoperative pancreatic fistula Yes, drain replacement Table 1 Patient demographics, operative factors and outcomes. |
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ISSN: | 0002-9610 1879-1883 |
DOI: | 10.1016/j.amjsurg.2024.01.003 |