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RISS 인기검색어
- 검색키워드
- 저자 : Kunal Bikram Deo (검색결과 2 건)
- 무료
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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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Review of Series of 9 Cases of Hepatolithiasis Managed at Community-Based Hospital of Nepal
( Sujan Gautam ),( Narendra Pandit ),( Laligen Awale ),( Kunal Bikram Deo ),( Tek Narayan Yadav ),( Shailesha Dhikary ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Hepatolithiasis is a rare disease with high rate of treatment failure and recurrence. This study aims to review the management and outcome of hepatolithiasis from an endemic region. Methods: Retrospective review of prospectively maintained database of patients with hepatolithiasis managed surgically (2015- 2019) was performed. Diagnosis was based on the clinical findings and radiological investigation (CT/MRI). Demographic data, clinical presentation, extent of disease and operative procedure were evaluated. The outcome measures included immediate stone clearance, postoperative complications. Results: Hepatolithiasis was seen in nine (0.34%) out of 2,600 patients being evaluated for gallstone disease. Three patients were young, while the remaining six were in the middle-age group. Seven (78%) were females. The presenting symptoms were abdominal pain (78%) and jaundice (22%). Hepatolithiasis was located in the left, right and bilateral ductal systems in 5, 1 and 3 patients respectively. Concomitant cholelithiasis and choledocholithiasis was seen in 6 (66.6%) patients each. Liver resection for unilateral disease was done in 3 (33.3%) patients: left hepatectomy- (n=2) and left lateral segmentectomy (n=1). High bile duct exploration and bilio-enteric drainage was done in 5 patients. One patient required hepatolithotomy and T-tube drainage due to cholangitis. Complete stone clearance was achieved in 78% of patients. Complications included minor surgical site infection and cholangitis in two patients. Histopathology revealed recurrent pyogenic cholangitis. At median follow-up of 28 months, 78% are symptom-free. Conclusions: Hepatectomy is an effective treatment when disease is confined to the left lobe. Combined surgical procedure is an acceptable option for bilateral or right-sided hepatolithiasis.
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