High risk pathogens and risk factors for postoperative pancreatic fistula after pancreatectomy; a retrospective case-controlled study

Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review

“…Hence, an exploration of microorganisms associated with CR-POPF naturally assists in this. Abe et al [ 162 ] reported Candida to be significantly associated with CR-POPF and an independent risk factor for grade C fistulae ( P = 0.043) which supported McMillan et al ’s findings where Candida was found in 87.3% of grade C cases for which microbiological data was available[ 157 ]. Here, Enterococcus and Staphylococcus were also detected, conflicting later findings by Belmouhand’s group who reported no significant difference in the severity of POPF when drain fluid was similarly contaminated[ 150 ].…”

Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition

“…Smoking is an established risk factor for the development of CR-POPF following both pancreatoduodenectomy and DP and this was confirmed in the present study. 70 The mechanism for this has not been confirmed beyond what is known about the impact of smoking on wound healing, 71 associated microangiopathy, 72 and increased fibrosis of the pancreas. 73,74 Similar relationships between smoking and diabetes and CR-POPF specifically after DP were demonstrated using univariate and multivariate analyses in a large singleinstitution study including 704 patients, 75 although the ISGPF 2005 definition was used.…”

Impact of microbiota-immunity axis in pancreatic cancer management

“…Coppola et al [ 60 ] found in the bile different microbes related to different complications: E. coli , Klebsiella pneumoniae (K. pneumoniae ), and Enterococcus faecalis were prevalent in surgical site infections; E. coli , K. pneumoniae , Enterococcus faecalis , and Enterococcus faecium were more abundant in POPF; and E. coli , Enterococcus faecalis and Enterococcus faecium were found in delayed empty gastric syndrome. Abe et al [ 61 ] analyzed the cultures of drainage fluid from patients undergoing pancreatic surgery. They found that the presence of Enterobacter species, Enterococcus species, and Candida species was significantly associated with clinically relevant POPF.…”

“…They found that the presence of Enterobacter species, Enterococcus species, and Candida species was significantly associated with clinically relevant POPF. Furthermore, the presence of Candida species resulted in being an independent factor for POPF C and POPF-related hemorrhages[ 61 , 62 ]. On the contrary, in other studies (with a restricted number of patients), bactobilia or fungal bile contamination were not reported to be associated with higher POPF rates or different global morbidity and mortality rates[ 58 , 63 ].…”