Pancreatic fistula after pancreatic head resection

Büchler, Markus W.; Frieß, Helmut; Wagner, Markus; Kulli, Christoph; Wagener, Veronika; Z’graggen, Kaspar

doi:10.1046/j.1365-2168.2000.01465.x

Cited by 389 publications

(335 citation statements)

References 40 publications

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“…However, the experienced surgeon's overall incidence of clinically relevant pancreatic fistulas was 10.8% in this study, which is a similar rate to what other studies have reported 2, 3, 5. The pancreatic anastomosis technique has been considered to be the most important factor in fistula development 26, 27. Even though secondary operators use the pancreatic anastomosis technique of the experienced surgeon, fine differences in their technique could affect the development of POPF.…”

Section: Discussionsupporting

confidence: 83%

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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BackgroundMany studies have reported factors affecting pancreatic leakage after pancreaticoduodenectomy (PD), but there have been few reports on surgeon workload and post‐operative pancreatic fistula (POPF). This study was conducted to explore whether a surgeon's workload during PD impacts the occurrence of POPF.MethodsWe retrospectively analysed 270 consecutive patients who underwent PD between January 2008 and June 2013 by a single experienced surgeon. These patients were divided into those who underwent PD entirely by a single operator (group 1) and those who received reconstructions by other operators (group 2). Duct‐to‐mucosa pancreaticojejunostomy was performed on all patients. The International Study Group on Pancreatic Fistula criteria were used to define POPF.ResultsThere were 157 patients (58.1%) in group 1 and 113 patients (41.9%) in group 2. The post‐operative morbidity rate was comparable between the two groups (55.4% versus 52.2%; P = 0.603), but the clinical pancreatic fistula (grade B/C) rate was significantly different (10.8% versus 2.7%; P = 0.011). The overall post‐operative mortality was one patient (0.4%). Significant associations were found between clinical pancreatic fistulas and soft pancreas texture (P = 0.021), preoperative serum albumin level ≤3.5 g/dL (P = 0.012), other pathology besides pancreatic cancer (P = 0.027) and a single‐operator procedure (P = 0.019). A multivariate logistic regression analysis revealed that a single operator (odds ratio: 4.2, P = 0.029) was a significant predictive risk factor for clinically relevant POPF.ConclusionDividing the surgeon's workload in PD is associated with lower rates of POPF.

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Section: Discussionsupporting

confidence: 83%

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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“…More studies using the strict definition applied by the International Study Group of Pancreatic Surgery (ISGPS) [3] report that POPF rates vary between 3 % after pancreatic head resection [2,4] and up to 30 % following distal pancreatectomy [5][6][7]. Many risk factors for POPF have been identified, such as gender [8], body mass index (BMI) [9,10], status of the pancreatic parenchyma [11], diameter of the main pancreatic duct (MPD) [12], and kind of disease [13].…”

Section: Introductionmentioning

confidence: 99%

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

Zhang

Guo

et al. 2016

Indian J Surg

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Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, modelbuilding strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42 %), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71 %) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86 %) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula.

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“…The incidence of POPF after PD is around 5-10 % even in high-volume centres although rates of less than 4 % have been reported [23][24][25]. Most importantly, pancreatic leakage is still responsible for 33-88 % of post-operative deaths after pancreatic resection [26][27][28][29][30].…”

Section: Post-operative Pancreatic Fistula (Popf)mentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

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Pancreatic fistula after pancreatic head resection

Cited by 389 publications

References 40 publications

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

Pancreatoduodenectomy - Preventing Complications

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