Is occlusion of the main pancreatic duct by thermal ablation really safe? A surgical innovation assessed according to IDEAL recommendations
Moll, Xavier (Universitat Autònoma de Barcelona. Departament de Medicina i Cirurgia Animals)
Fondevila, Dolors (Universitat Autònoma de Barcelona. Departament de Medicina i Cirurgia Animals)
García Arnas, Félix (Universitat Autònoma de Barcelona. Departament de Medicina i Cirurgia Animals)
Pérez, Juan J. (Universitat Politècnica de València)
Ielpo, Benedetto (Hospital del Mar)
Sánchez-Velázquez, Patricia (Hospital del Mar)
Grande, L (Hospital del Mar)
Jaume, Sofía (Hospital del Mar)
Radosevic, Aleksandar (Hospital del Mar)
Barranco, Luis E (Hospital del Mar)
Berjano, Enrique (Universitat Politècnica de València)
Burdío, Fernando (Hospital del Mar)
Andaluz Martínez, Anna (Universitat Autònoma de Barcelona. Departament de Medicina i Cirurgia Animals)

Date:	2023
Description:	13 pàg.
Abstract:	Introduction: Pre-clinical studies suggest that thermal ablation of the main pancreatic duct (TAMPD) is more recommendable than glue for reducing postoperative pancreatic fistula (POPF). Our aims were (1) to analyze the changes in the pancreas of patients after TAMPD and (2) to correlate the clinical findings with those obtained from a study on an animal model. Materials and methods: A retrospective early feasibility study of a marketed device for a novel clinical application was carried out on a small number of subjects (n = 8) in whom TAMPD was conducted to manage the pancreatic stump after a pancreatectoduodenectomy (PD). Morphological changes in the remaining pancreas were assessed by computed tomography for 365 days after TAMPD. Results: All the patients showed either Grade A or B POPF, which generally resolved within the first 30 days. The duct's maximum diameter significantly increased after TAMPD from 1. 5 ± 0. 8 mm to 8. 6 ± 2. 9 mm after 7 days (p = . 025) and was then reduced to 2. 6 ± 0. 8 mm after 365 days PO (p < . 0001). The animal model suggests that TAMPD induces dilation of the duct lumen by enzymatic digestion of ablated tissue after a few days and complete exocrine atrophy after a few weeks. Conclusions: TAMPD leads to long-term exocrine pancreatic atrophy by completely occluding the duct. However, the ductal dilatation that occurred soon after TAMPD could even favor POPF, which suggests that TAMPD should be conducted several weeks before PD, ideally by digestive.
Grants:	Agencia Estatal de Investigación RTI2018-094357-B-C21 Agencia Estatal de Investigación RTI2018-094357-B-C22
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Animals ; Atrophy/pathology ; Pancreas/surgery ; Pancreatic Ducts/surgery ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Postoperative Complications ; Retrospective Studies ; Pancreatic duct ; Thermal ablation ; Duct occlusion ; Postoperative pancreatic fistula ; IDEAL recommendations ; SDG 3 - Good Health and Well-being
Published in:	International Journal of Hyperthermia, Vol. 40 Núm. 1 (2023) , p. 2203888, ISSN 1464-5157

DOI: 10.1080/02656736.2023.2203888
PMID: 37126121

14 p, 5.3 MB

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