Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

Nong, Kate; Zhang, Yue; Liu, Shengyong; Yang, Yue; Sun, Donglin; Chen, Xuemin

doi:10.1177/0300060520943422

Cited by 7 publications

(4 citation statements)

References 37 publications

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“…Additionally, various risk factors, including soft tissue texture, small pancreatic duct[ 30 ], ischemia, ductal obstruction, excessive blood loss, high intraoperative fluid intake[ 31 ], elevated bilirubin level, large body mass index[ 32 ], low fibrosis[ 33 ], high acinar cell density, and acinar marginal content[ 34 ], increase the complexity of surgical maneuvers, resulting in anastomotic failure due to the heightened local tension created by inflammation and reflux.…”

Section: Discussionmentioning

confidence: 99%

Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature

Wang,

Tian,

Zhang

et al. 2024

World J Clin Cases

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BACKGROUND Postoperative pancreatic fistula (POPF) contributes significantly to morbidity and mortality after pancreaticoduodenectomy (PD). However, the underlying mechanisms remain unclear. This study explored this pathology in the pancreatic stumps and elucidated the mechanisms of POPF following PD. CASE SUMMARY Pathological analysis and 16S rRNA gene sequencing were performed on specimens obtained from two patients who underwent complete pancreatectomy for grade C POPF after PD. Gradient inflammation is present in the pancreatic stump. The apoptosis was lower than that in the normal pancreas. Moreover, neutrophil-dominated inflammatory cells are concentrated in the ductal system. Notably, neutrophils migrated through the ductal wall in acinar duct metaplasia-formed ducts. Additionally, evidence indicates that gut microbes migrate from the digestive tract. Gradient inflammation occurs in pancreatic stumps after PD. CONCLUSION The mechanisms underlying POPF include high biochemical activity in the pancreas, mechanical injury, and digestive reflux. To prevent POPF and address pancreatic inflammation and reflux, breaking the link with anastomotic dehiscence is practical.

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Section: Discussionmentioning

confidence: 99%

Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature

Wang,

Tian,

Zhang

et al. 2024

World J Clin Cases

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show abstract

“…Additionally, various risk factors, including soft tissue texture, small pancreatic duct [32], ischemia, ductal obstruction, excessive blood loss, high intraoperative uid intake [33], elevated bilirubin, large body mass index [34], low brosis [35], high acinar cell density and acinar marginal content [36], increase the complexity of surgical maneuvers, resulting in the anastomotic failure due to the heightened local tension created by in ammation and re ux.…”

Section: Discussionmentioning

confidence: 99%

Inflammation and digestive reflux in the pancreatic stump after pancreaticoduodenectomy

Wang

Tian

et al. 2023

Preprint

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Background and Objectives: Postoperative pancreatic fistula (POPF) contributes to significant morbidity and mortality after pancreaticoduodenectomy (PD). However, the underlying mechanisms of POPF remain unclear. This study is to explore the pathology in the pancreatic stump and elucidates the mechanisms of POPF following PD. Methods: Pathological analysis and 16S rRNA gene sequencing were performed on the specimens obtained from the two patients who accepted complete pancreatectomy for grade C POPF after PD. In addition, a retrospective radiological analysis was conducted on a cohort of 125 consecutive patients who underwent PD to evaluate the inflammatory response in the pancreatic stump. Results: The presence of gradient inflammation and acinar-duct metaplasia (ADM) in the pancreatic stumps is ubiquitous. The incidence of apoptosis is markedly reduced in the pancreatic stump. Moreover, a significant accumulation of neutrophil-dominated inflammatory cells is detected in the ductal system. Notably, the ADM-formed duct is the site where the neutrophils transmigrate through the ductal wall. Additionally, the microbial evidence indicates that gut microbes migrate from the digestive tract. Radiological analysis proves that a gradient of pancreatitis exists in all cases after PD and reaches peak on the fourth postoperative day. Conclusions: Inflammation and digestive reflux exist in the pancreatic stump after PD. The underlying mechanisms of POPF are the high biochemical activity of the pancreas, mechanical injury, and digestive reflux.

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“…Vitamin K1 was used to improve coagulation function for patients with jaundice. However, whether it is necessary to reduce jaundice before surgery is still controversial [ 43 ]. Conservative treatment is the cornerstone of postoperative PF management [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

et al. 2022

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Background To explore the application value of free omental wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD). Methods The clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analysed. In total, 86 cases were divided into Group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases were divided into Group B (control group). The incidences of postoperative pancreatic fistula and other complications were compared between the two groups, and univariate and multivariate logistic regression analyses were used to determine the potential risk factors for postoperative pancreatic fistula. Risk factors associated with postoperative overall survival were identified using Cox regression. Results The incidences of grade B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in Group A were lower than those in Group B, and the differences were statistically significant (P < 0.05). Group A had an earlier drainage tube extubation time, earlier return to normal diet time and shorter postoperative hospital stay than the control group (P < 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) inflammatory factors 1, 3 and 7 days after surgery also showed significant. Univariate and multivariate logistic regression analyses showed that a body mass index (BMI) ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P < 0.05). Cox regression analysis showed that age ≥ 65 years old, body mass index ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap isolation and modified pancreaticojejunostomy, and malignant postoperative pathology were independent risk factors associated with postoperative overall survival (P < 0.05). Conclusions Wrapping and isolating the modified pancreaticojejunostomy with free greater omentum can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and favourably affect prognosis.

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Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

Cited by 7 publications

References 37 publications

Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature

Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature

Inflammation and digestive reflux in the pancreatic stump after pancreaticoduodenectomy

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

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