A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients

Abstract

The development of a POPF does not always determine a substantial change of the postoperative management. Clinically relevant fistulas can be treated conservatively in most cases. Higher fistula severity corresponds to increased costs. The grading system proposed by the ISGPF allows a correct stratification of the complicated patients based on the real clinical and economic impact of the POPF.

Histomorphological Features of the Pancreatic Remnant as Independent Risk Factors for Postoperative Pancreatic Fistula: A Matched-Pairs Analysis

“…It is associated with both local and general complications such as abscess formation, bleeding, wound infection, delayed gastric emptying, respiratory complications and sepsis, thus leading to a prolonged hospital stay, higher rates of revisional surgery and substantial costs [3,4,5,6,7,8,9,10]. …”

Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience

“…This distribution differs from the POPF grades after pancreatic surgery. In a large case series of 775 patients after pancreaticoduodenectomy, 147 patients (19.5%) developed a POPF [8]. According to the ISGPF criteria, incidence of grades A, B and C POPF was 19.0, 70.7 and 8.8%, respectively.…”

“…While the rate of incidence of pancreatic fistulae (POPF) after pancreatic surgery is up to 40% [8,9], this complication is relatively unknown after surgery for urologic diseases.…”

Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy

“…Risk factors for POPF after PD include advanced age [8,9], male gender [6,8,10], obesity and high body mass index [11,12], comorbid cardiovascular diseases [13,14], lack of neoadjuvant chemoradiotherapy [15][16][17] disease pathology [4,8,10,12], soft pancreatic texture [6,8,12,13,18], small pancreatic duct [8,12,18,19], absence of pancreatic parenchymal fibrosis [18,20,21], increased pancreatic fatty infiltration [20,21], large pancreatic remnant volume [22], prolonged operation time [6,10], greater intraoperative blood loss [20], failure to use optical magnification when constructing the pancreatic anastomosis [23,24], and hospital patient volume [25,26].…”

“…Pancreaticoduodenectomy (PD) is a complex operation associated with a high morbidity rate of 30-50%, even in high-volume centers [1][2][3][4] Although over 70 different techniques for reconstruction of the pancreatic remnant have been proposed [5], postoperative pancreatic fistula (POPF) still accounts for most surgical complications after PD, and it sometimes leads to life-threatening complications such as intra-abdominal infections, severe sepsis, and massive bleeding [3,6,7].…”