Pancreatic Fistula Rate after Pancreatic Resection

Abstract

Background: Pancreatic fistula (PF) is still regarded as a serious complication both in terms of frequency and sequelae. The incidence varies greatly in different reports because of the different definitions used. The aim of this study was to compare several definitions of PF encountered in the current literature and to demonstrate that the PF rate in the same group of patients treated in a high volume center is dependent upon the definition applied. Methods: A Medline search of the last 10 years was performed as regards the definition of PF. A score was assigned to the reproducible definitions based upon two basic parameters: daily output (cm³) and duration of the fistula represented by the number of days between the postoperative day of onset and the duration of the complication. Four definitions were formulated and were then applied to a group of 242 patients that underwent pancreatic head or intermediate resections with pancreatico-jejunal anastomosis in our Pancreatic Unit between November 1996 and December 2000. Statistical analysis was carried out using the Yates correct χ² test with statistical significance set at p < 0.05. Results: Among 26 different definitions identified, 14 were found suitable for the applied score. We formulated four final definitions summarizing the current concepts of PF. The incidence of PF ranged between 9.9 and 28.5% according to the different definitions applied with highly statistical differences between them. Conclusions: The PF rate after pancreatic resections is strictly dependent upon the definition used. An overall general agreement for an internationally accepted definition is urgently needed to correctly compare different experiences.

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

“…Using the definition proposed by the International Study Group on Pancreatic Fistula [11], we made the diagnosis of pancreatic fistula on postoperative day 7 in the cases of 22 of the 27 patients (81%) with pancreatic fistula. This result confirms the high sensitivity (70-75%) of clinical and biologic criteria for the diagnosis of pancreatic fistula reported in the literature [14,16,17]. CT performed on postoperative day 7 depicted a perianastomotic collection in 13 of our 22 patients (59%) with overt pancreatic fistula.…”

“…Likely explanations for the high incidence of pancreatic fistula in our study are, first, a definition of pancreatic fistula that relies not only on imaging findings but also on clinical and biologic data and, second, inclusion only of patients with a soft pancreas, a well-recognized risk factor for the development of pancreatic fistula [1,5,7,10,15]. In the surgical literature, terms such as pancreatic leak, pancreatic leakage, and pancreatic fistula are used alternately [17]. We consider the last the most appropriate for indicating failure of healing and sealing of the pancreaticogastric or pancreaticojejunal anastomosis.…”

“…Although some authors [2,3] routinely perform postoperative CT and include CT in the criteria for pancreatic fistula diagnosis, others [17] do not recommend CT in the diagnosis of pancreatic fistula because of the high prevalence of transient intraabdominal fluid collections after pancreaticoduodenectomy [22]. In an effort to clarify the role of CT in the diagnosis of pancreatic fistula after pancreaticoduodenectomy, we evaluated the sensitivity and specificity of routine CT on postoperative day 7 in patients at high risk of pancreatic fistula.…”

Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer

“…There are multiple definitions and grading systems for pancreatic leaks, and reported rates of leak will vary depending upon which definition is used [19]. The pancreatic leaks in this analysis were managed mainly conservatively and there were no peri-operative mortalities, meaning most were low grade, or grade A according to the International Study Group on Pancreatic Fistula [20].…”

Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients

“…This substantial variation may be explained by case mix, but more importantly because of different definitions of POPF. In a review from 1991 to 2000, 26 different definitions of what constitutes a POPF could be identified [20]. The ISGPF definition of POPF was presented and shortly thereafter modified in 2005 and divided, based on clinical severity, this complication into three grades [9].…”