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RISS 인기검색어
- 검색키워드
- 저자 : Aditya Atul Kulkarni (검색결과 2 건)
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( Rajesh Gupta ),( Aditya Atul Kulkarni ),( Rahul Gupta ),( Sunil Shenvi ),( Tanvi Jain ),( Raghavendra Babu ),( Mandeep Kang ),( Surinder Rana ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Step-up approach is becoming a standard of care for management of acute necrotizing pancreatitis. We aimed to investigate the learning curve effect and increasing experience on management and outcomes of surgical step-up approach at our high-volume tertiary referral center. Methods: In a retrospective analysis of database of patients with acute necrotizing pancreatitis referred to our unit, we divided patients into three distinct time periods: Group-1 (2008-2012), Group-2 (2013-2016) and Group-3 (2017-2019). Outcomes between different time periods were compared. Results: Total of 335 patients were included, with 92 patients in Group-1, 117 in Group-2 and 126 in Group-3. Patients treated on surgical side in later time period had higher incidence of multiorgan failure (26.1% vs. 49.6% vs. 45.2%, P<0.001), APACHE II scores at presentation (8 vs. 10 vs. 9, P=0.006) and at first intervention (9 vs. 11 vs. 10, P=0.037), as well higher mCTSI score (8 vs. 10 vs. 10, P<0.001). Over time, median percutaneous drain size (10Fr vs. 12Fr vs. 14 Fr, P<0.001) as well as sepsis reversal after drainage (40.2% vs. 59% vs. 49.2%, P=0.026) increased, whereas median number of drains (P=0.001) and interventions (4 vs. 3 vs. 3, P=0.005) decreased significantly. Necrosectomy requirement, length of stay and mortality remained similar over time despite more severe cases referred to surgical side. Conclusions: With increasing experience of step-up approach, sicker patients with higher severity of pancreatitis could be managed successfully with fewer drains and procedures leading to significantly higher sepsis reversal with drainage, with no increase in surgery requirement or mortality.
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Impact of diabetes mellitus on morbidity and survival after pancreaticoduodenectomy for malignancy
Kunal Bikram Deo,Aditya Atul Kulkarni,Praveen Kumar-M,Gautham Krishnamurthy,Sunil Shenvi,Surinder Singh Rana,Rakesh Kapoor,Rajesh Gupta 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2
Backgrounds/Aims: Diabetes mellitus (DM) is a known risk factor for morbidity, length of hospital stay, or mortality after surgery, however, its impact on postoperative course and long-term survival after pancreaticoduodenectomy (PD) is not clear. Methods: This is a retrospective analysis of prospectively maintained database of 141 patients with periampullary and pancreatic head adenocarcinoma operated between January 2001 and March 2019. Clinico-pathological records and follow-up data were retrieved and analyzed. Cumulative hazard was computed for comparing the survival between DM and non-DM. Results: DM was present in 31/141 (21.9%) patients, while 16/31 (51.6%). were new-onset DM (NODM). Tumor size, lymphovascular & perineural invasion, type of surgery, lymph node positivity and R0 resection rate were comparable between diabetic and non-diabetic. There was no significant difference in postoperative pancreatic fistula, delayed gastric emptying, infectious complication, hospital stay and mortality between DM and non-diabetics. Patients with DM had worse survival at 3 years (OS: HR, 3.11 [1.43-6.76] p=0.004, DFS: HR, 2.61 [1.23-5.53] p=0.01) and 5 years (OS: HR, 3.32 [1.46-7.53] p=0.004, DFS: HR, 2.87 [1.29-6.41] p=0.009). On multivariate analysis, DM (3 year OS: HR, 2.61 [1.14-5.98] p=0.022, DFS: HR, 2.19; p=0.058) (5 year OS: HR, 2.55; p=0.04, DFS: HR, 2.25; p=0.068) and pylorus resecting surgery were significantly associated with worse survival at 3 and 5 years. Conclusions: Preoperative DM has no significant effect on postoperative course but has negative impact on 3-year and 5-year OS and DFS after PD for pancreatic and periampullary adenocarcinoma.
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