Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register‐Based Study

Williamsson, Caroline; Stenvall, Kristina; Wennerblom, Johanna; Andersson, Roland; Andersson, Bodil; Tingstedt, Bobby

doi:10.1007/s00268-020-05735-4

Cited by 26 publications

(39 citation statements)

References 52 publications

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“…In a retrospective study using Swedish national data, Williamsson et al (n = 2503) found incidence of CR-POPF was 10.0%; this correlated with major morbidity (75% versus 21%, p < 0.001) and longer length of stay (23 versus 11 p < 0.001). 6 Obesity (OR 1.08, p < 0.001) was a risk factor, whereas diabetes (OR 0.58, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) were protective. 6 CR-POPF was significantly more likely in patients who underwent pancreatojejunostomy (PJ) compared with pancreatogastrostomy (PG, OR 2.41, p < 0.001).…”

Section: Pancreatic Fistulamentioning

confidence: 95%

Procedure‐specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors

Russell

Aroori

2022

ANZ Journal of Surgery

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Background Pancreatoduodenectomy (PD) remains the only curative‐intent treatment option for patients with cancer affecting the head of the pancreas. It is high‐risk and overall morbidity is around 40%. Due to the necessary resection and subsequent anastomoses required, multiple procedure‐specific complications are possible. An in‐depth understanding of the recent evidence on these will guide the consenting process and allow surgeons to evaluate their own performance. We aimed to consolidate the recent literature on preselected PD complications (postoperative pancreatic fistula (POPF), bile leak (BL), gastrojejunal leak, postpancreatectomy haemorrhage (PPH), cholangitis, and chyle leak (CL)). Methods A search of the PubMed database was carried out on 1st July 2021. Articles from July 2011 through to July 2021 were included. The initial search returned 297 results. After screening, 226 articles were excluded. The remaining 71 were assessed for eligibility and a further 34 were excluded. 37 were included in the final synthesis (two meta‐analyses and 35 single/multicentre studies). Results Due to recently updated diagnostic criteria, differing definitions among authors and subclinical cases, true incidence rates are difficult to appreciate. The following were obtained: POPF (excluding biochemical leak): 10.0–25.9%, BL: 3.0–7.9%, gastrojejunal anastomotic leak: 0.4–1.2%, PPH: 7.3–13.6%, cholangitis: 0.05–21.1% and CL: 2.6–19.0%. Numerous risk factors, both modifiable and non‐modifiable, were identified for each. Conclusion Most of the recent evidence on the studied complications comes from single institution studies of retrospective design. Robust case–control studies are required so predictive models can estimate the likelihood of specific complications in individual patients.

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Section: Pancreatic Fistulamentioning

confidence: 95%

Procedure‐specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors

Russell

Aroori

2022

ANZ Journal of Surgery

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“…Braga[56] considered that the increase in BMI, the presence of fatty pancreas and pancreatic brosis were the risk factors for pancreatic stula after surgery, and based on these three factors, pancreatic stula could be scored and predicted, and then preventive measures could be formulated. It has been reported in the literature that total pancreatic fat in patients with diabetes is signi cantly reduced and brosis aggravates, which actually plays a protective role for patients with POPF [57]. A univariate and multivariate regression analysis of BMI in 175 patients in this retrospective study revealed that BMI was an independent risk factor for pancreatic stula.…”

Section: Discussionmentioning

confidence: 53%

Application Analysis of Omental Flap Isolation and Modified Pancreaticojejunostomy in Pancreaticoduodenectomy (175 Cases)

Deng

Luo

Ouyang

et al. 2021

Preprint

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Background: To explore the application value of free omentum 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 analyzed. All patients were divided into 86 cases in group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases in group B (control group). The incidence of pancreatic fistula and other related complications, inflammatory factors and survival rate were compared between the two groups.Results: The incidences of B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in group A were lower than those in group B, and the difference was statistically significant (P <0.05). The free omentum wrapping isolation and the modified pancreaticojejunostomy group drainage tube extubation time, open diet time and postoperative hospital stay were earlier than the control group (P <0.05). There were also statistically significant differences in CRP, IL-6, PCT inflammatory factors 1, 3, and 7 days after surgery as well as in postoperative survival rate.Univariate analysis showed that BMI, pancreatic duct diameter, greater omental flap isolation and modified pancreaticojejunostomy were related to the occurrence of pancreatic fistula after PD. Multivariate analysis showed that BMI≥24, pancreatic duct diameter less than 3mm, no greater omental flap isolation method and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P<0.05).Conclusions: Wrapping and isolating with free greater omentum plus modified pancreaticojejunostomy can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and is conducive to the prognosis.

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“…In this study, most patients undergoing PD prior to 2017 had ampullary tumors (53.5%), while most patients undergoing PD after 2017 had pancreatic head tumors (68.2%). A previous study reported that pancreatic head tumors had signi cantly decreased incidences of POPF, which may be due to the parameters associated with in ammation of the parenchyma or obstruction of the pancreatic duct leading to pancreatic rmness [18]. However, a soft pancreas has been associated with fatty in ltration.…”

Section: Discussionmentioning

confidence: 96%

Postoperative pancreatic fistulas after pancreaticoduodenectomy using the pair-watch suturing and duct-to-mucosa pancreaticojejunostomy anastomosis techniques

Passawart

Rungsrithananon

Jaseanchiun

2022

Preprint

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Background/Aims: Morbidity and mortality after pancreaticoduodenectomy (PD) have been associated with postoperative pancreatic fistula (POPF). Pancreatic anastomosis is challenging for most surgeons, and there is no universal or standardized technique. This study compared the incidence of POPF between the pair-watch suturing technique (PWST) and duct-to-mucosa pancreaticojejunostomy (PJ) anastomosis technique.Methods: This retrospective cohort analysis included 71 patients who underwent a PD between January 2009 and October 2018. The incidence and risk factors of complications after PWST and duct-to-mucosa PJ anastomoses were compared.Results: There was no significant difference in the incidence of POPF between the PWST (n=7; 30.4%) and duct-to-mucosa PJ (n=9; 18.7%) groups. The tumor site (p=0.001) and pancreas density on computed tomography without contrast (p=0.002) were significantly different between the groups. Age ≥60 years (odds ratio [OR]: 11.07; 95% confidence interval [CI]: 1.14–107.36; p=0.038) and pancreatic body mass/duct size (B/W) ratio (OR: 1.41; 95% CI: 1.04–1.91; p=0.029) were identified as significant risk factors for POPF. International Study Group for Pancreatic Fistula grade B POPF, wound infections, and pneumonia occurred more frequently in patients who underwent a duct-to-mucosa PJ anastomosis. However, the postoperative complications were not significantly different between the groups.Conclusions: The incidence of clinically relevant POPF was similar between patients who underwent the PWST and those who underwent a duct-to-mucosa PJ anastomosis. However, a preoperative risk factor assessment for the evaluation of the tumor site, patient age, and B/W ratio could help determine which surgical technique should be used in individual patients.

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Predictive Factors for Postoperative Pancreatic Fistula—A Swedish Nationwide Register‐Based Study

Cited by 26 publications

References 52 publications

Procedure‐specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors

Procedure‐specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors

Application Analysis of Omental Flap Isolation and Modified Pancreaticojejunostomy in Pancreaticoduodenectomy (175 Cases)

Postoperative pancreatic fistulas after pancreaticoduodenectomy using the pair-watch suturing and duct-to-mucosa pancreaticojejunostomy anastomosis techniques

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