Posts

More Patients to Receive Wound Vacs After Their Pancreatic Surgery

The following summary comes from Javed et al. and was recently published in the Annals of Surgery, the preeminent surgical journal, in June 2019.

https://journals.lww.com/annalsofsurgery/Fulltext/2019/06000/Negative_Pressure_Wound_Therapy_for_Surgical_site.7.aspx

Despite a substantial decreased in the mortality associated with the Whipple procedure, postoperative complications, albeit non-life-threatening are frequently observed. Surgical site infections are a common complication, and in the immediate postoperative period add morbidity and in the long run can impact long-term outcomes in patients with pancreatic cancer due to delays in receipt of systemic therapy after surgery. Simply put, a surgical site infection occurs when pathogens such as bacteria infect the incision site. In case of a surgical site infection, in the days following the surgery, the incision often becomes tender, swollen and red, and purulent discharge may be observed. Management of this complication can range from antibiotic administration to need for a reoperation, depending on its severity. Surgical site infections can prolong hospitalization, result in readmissions, and increase healthcare costs. Individuals considered “high risk” for surgical site infections are those who have either undergone preoperative stenting of the bile duct or received neoadjuvant chemotherapy, or both. In this population the rate of surgical site infections of over 30% has been reported. 

 

Given this knowledge, this study sought to evaluate the impact of negative pressure wound therapy (sometimes referred to as “wound vacs”) on the rate of this complication. The authors conducted a randomized controlled trial evaluating the benefit of using this device in high risk patients. Patients were randomly assigned to receive the device or a standard wound closure. The device consists of a foam dressing over the incision that is connected to vacuum suction via tubing and works by keeping the incision dry (less favorable for growth of pathogens). 

 

Over a one-year period, 123 high risk patients who underwent Whipple procedure were included in the study. Surgical site infection occurred in 9.7% (6/62) of patients who received the device and in 31.1% (19/61) of patients in the standard closure group (P = 0.003). The relative reduction in risk of developing surgical site infection was 68.8%. Furthermore, on cost analysis surgical site infections were found to independently increase the cost of hospitalization by approximately 23.8%.

The use of negative pressure wound therapy resulted in a significantly lower risk of SSIs. Incorporating this intervention in surgical practice can help reduce a complication that significantly increases postoperative morbidity and healthcare costs.

Take home points:

  1. Surgical site infections are common, especially in high risk patients following the Whipple procedure.
  2. Negative pressure wound therapy (or wound vacs) can lower the risk of surgical site infections in high risk patients by almost 70%.

 

 

 

 

 

Image- KCI Negative Pressure Wound Therapy dressing. Image credit: https://www.kci-medical.sg/SG-ENG/vactherapy

Safety of Robotic Whipples

 

Above is a photo of the da Vinci Surgical System. Not seen, is the surgeon’s console station. At the console, the surgeon sits aside the robot and can manipulate the robot’s arms to perform the surgery. Whereas a surgeon only has two arms, the robot seen above has four. These additional arms give the surgeon more options during the surgery.
Image credit: https://www.intuitive.com

The following summary comes from Emanuele F. Kauffmann, MD and colleagues, and was recently published in Surgical Endoscopy in January 2019.

Link to article: https://link.springer.com/article/10.1007%2Fs00464-018-6301-2

Over the recent decades, improvements in preoperative management and introduction of new surgical techniques has seen a substantially declined the morbidity (rate of complications) associated with pancreatic surgery. Among these, the most intriguing innovations has been the introduction of the surgical robot as a tool to assist the surgeon. When using this platform, surgeons may enjoy increased control, a 3-D view of the abdomen, and greater magnification of the surgical field, while minimizing the length of required incisions. In this article, the authors sought to evaluate the outcomes of robotic pancreatic oduodenectomy (also known as the Whipple procedure) as compared to its classic open counterpart. The authors chose to evaluate immediate oncological outcomes including resection margin status (see our August blog post on resection margins for more information). Additionally, they evaluated long-term patient outcomes including recurrence of disease and overall survival.

In order to draw meaningful conclusions, the authors performed a propensity score match. It is a widely used statistical tool that allows us to balance groups of patients that otherwise in the real world might not be similar due to various aspects of clinical decision making. Based on features of patients in one group, patients with similar characteristics are identified from the other group that serve as a control. Once done these selected groups are compared rather than the entire patient population.

Encouragingly, there were no differences observed in the rates of negative resection margins in both groups. Additionally, the authors found that the long-term outcomes including recurrence of disease and overall survival were equivalent regardless of robotic or open surgical approach.

Take home points:

  1. Surgeons can perform the same procedure, using either techniques to achieve similar rates of tumor clearance.
  2. Patients who undergo a Whipple via either technique have similar long-term outcomes.

It is important to remember that each patient and their disease is unique. Consequently, some patients may not be ideal candidates for a robotic approach. Furthermore, surgical experience and training in using a robotic console are required to use it effectively. Therefore, it should be expected that these similar outcomes are achieved when the surgeons performing the robotic procedures are trained in the field, and are past their learning curve.

NMF Raises $7,000 from Annual Online Auction

The Nikki Mitchell Foundation’s annual auction closed Monday, March 25th.  The auction raised over $7,000, sold 10 items and brought in around 40 bidders from 12 states. Funds raised benefit the non-profit whose mission is to prevent, detect and cure pancreatic cancer.

Nikki Mitchell, the foundation’s namesake, was Waylon Jennings’ business manager for 22 years and the foundation has close ties to the music industry. The auction included items from Jamey Johnson, Kris Kristofferson, Willie Nelson, Alison Krauss and Brad Paisley. In addition to the country music auction items, unique art like a hand carved skulls and wood signs were sold.