Neuroendocrine Pancreatic Tumors Are Risk Factors for Pancreatic Fistula after Pancreatic Surgery

Abstract

Background: Postoperative pancreatic fistula (PF) is still regarded as a major complication in pancreatic surgery. In the present study, we evaluated the risk of PF in a large study population of patients with neuroendocrine pancreatic tumors (NPT), pancreatic cancer (PC), and chronic pancreatitis (CP). Methods: Patients who underwent pancreatic surgery between 1989 and 2008 at our institution were retrospectively evaluated. Patients were analyzed regarding age, gender, BMI, alcohol, smoking, preoperative diabetes, reason for operation, operative procedure, and PF. Three different grades of PF (grades A, B, C) were defined. Results: 133 patients with NPT, 212 patients with PC, 52 patients with CP, and 76 patients with other reasons were evaluated. Patients with a NPT had a significant higher risk of developing a PF than patients with PC, CP, or other reasons (p = 0.0001). Enucleation of the tumor was associated with the highest rate of PF (p = 0.001). In a multivariate analysis, BMI >26, and preoperative diabetes were associated with a higher rate of PF (p = 0.042 and p = 0.02, respectively). Conclusion: We demonstrated that after excluding factors like different definitions of PF, or different peri- or postoperative management, patients with NPT have a significantly higher risk of postoperative PF than patients with other pancreatic diseases.

Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions

“…Pancreatic lesions that usually do not cause fibrotic reactions, such as PNET are generally not associated with pancreatic duct obstruction. High fistula rates after resections for PNET have been described accordingly …”

“…Underlying pathology is also correlated with the incidence of POPF as adenocarcinoma and chronic pancreatitis are typically associated with firm, fibrotic and thereby easily sutured glands, whereas other peri‐ampullary cancers and benign processes are associated with a soft gland . PNET rarely cause duct dilatation and fibrosis, and could therefore be associated with increased rates of POPF …”

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

“…High-volume pancreatic resection is a crucial criterion for having an acceptable risk of postoperative complications and surgeryrelated deaths [90] . Additionally, it should be pointed out that pancreatic surgery for PanNETs is associated with a higher risk compared with other pancreatic malignancies [91,92] . Patients with PanNETs usually have potential risk factors for pancreatic fistula such as a soft pancreatic texture and a non-dilated main pancreatic duct.…”

“…Rates of postoperative complications are classified according to the type of pancreatic resection. For standardized pancreatic resection, the rate of postoperative complications is around 30-50% with a mortality risk for pancreaticoduodenectomy and distal pancreatectomy of less than 5% and less than 1%, respectively [91,[93][94][95] .…”

A Simple and Safe Anastomosis for Pancreatogastrostomy Using One Binding Purse-String and Two Transfixing Mattress Sutures

“…There occurred two type A and one type B fistula, which all three resolved without any radiological intervention or reoperation. A soft consistency of the pancreatic remnant in ampullary, duodenal, and especially neuroendocrine diseases provide a significantly higher risk of pancreatic fistula [24, 25]. Several groups showed that the rate of pancreatic fistula in high-risk patients with a small fragile soft pancreatic remnant and a non-dilatated pancreatic duct was as high as 36% compared to only 2–4% in low-risk patients with a fibrotic pancreatic remnant composed of dense tissue [26–29].…”