Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula

Lin, John; Cameron, John L.; Yeo, Charles J.; Riall, Taylor S.; Lillemoe, Keith D.

doi:10.1016/j.gassur.2004.09.044

Cited by 338 publications

(314 citation statements)

References 25 publications

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“…Alternatively, the presence of non‐pancreatic cancer diseases such as ampullary, biliary, or neuroendocrine tumors were indicated as a risk factor, because these diseases clearly reflect the remnant pancreatic characteristics of soft pancreatic texture, a thin pancreatic body, and a non‐fibrotic pancreatic parenchyma, which greatly increases the risk of a PF. Moreover, the comorbidities of myocardial infarction and peripheral vascular disease were also demonstrated as significant factors of a PF grade C. In the previous report, coronary artery disease was identified as a risk of PF because arterial sclerosis decreased visceral perfusion, which leads to anastomotic ischemia 22, 26. Arterial sclerosis implies vascular fragility and it also may lead to PF grade C, because slight surgical damage to the vascular wall may cause an aneurysm to develop during the postoperative course.…”

Section: Discussionmentioning

confidence: 95%

Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan

Aoki

Matsubara

Konno

et al. 2017

J Hepatobiliary Pancreat Sci

128

138

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BackgroundThe morbidity rate after pancreaticoduodenectomy remains high. The objectives of this retrospective cohort study were to clarify the risk factors associated with serious morbidity (Clavien–Dindo classification grades IV–V), and create complication risk calculators using the Japanese National Clinical Database.MethodsBetween 2011 and 2012, data from 17,564 patients who underwent pancreaticoduodenectomy at 1,311 institutions in Japan were recorded in this database. The morbidity rate and associated risk factors were analyzed.ResultsThe overall and serious morbidity rates were 41.6% and 4.5%, respectively. A pancreatic fistula (PF) with an International Study Group of Pancreatic Fistula (ISGPF) grade C was significantly associated with serious morbidity (P < 0.001). Twenty‐one variables were considered statistically significant predictors of serious complications, and 15 of them overlapped with those of a PF with ISGPF grade C. The predictors included age, sex, obesity, functional status, smoking status, the presence of a comorbidity, non‐pancreatic cancer, combined vascular resection, and several abnormal laboratory results. C‐indices of the risk models for serious morbidity and grade C PF were 0.708 and 0.700, respectively.ConclusionsPreventing a PF grade C is important for decreasing the serious morbidity rate and these risk calculations contribute to adequate patient selection.

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Section: Discussionmentioning

confidence: 95%

Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan

Aoki

Matsubara

Konno

et al. 2017

J Hepatobiliary Pancreat Sci

128

138

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“…In the great majority of cases pancreatic fistula responds well to conservative management with octreotide but high out fistulas and cases not responding to conservative management may require operative intervention [14]. Operative options available for pancreatic fistula are relaparotomy and drainage, repair of anastomotic leakage site or completion pancreatectomy [15][16][17]. But relaparotomy in these patients adds a greater risk and usually have a poorer prognosis.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy in a Government Medical College—Should We Proceed!!!

Patra

Basu

et al. 2010

Indian J Surg

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The value of standard Pancreaticoduodenectomy for Periampullary carcinomas has long been a matter of debate. Though the mortality has dramatically reduced in high volume centers with dedicated hepatobiliary surgery units, the rate is still high in peripheral institutes. In this study our aim was to access the overall post operative outcome associated with pancreaticoduodenectomy performed in a government medical college. A total of 44 patients who underwent pancreaticoduodenectomy for operable periampullary cancers were evaluated. The overall morbidity rate was 31.1%. A total of 13 (29.5%) died following the operation and of its complications though the rate has reduced drastically to 14.2% in2008. The average length of hospital stay was 22 days. The mean survival was 15 months. Pancreaticoduodenectomy can safely be performed in government medical colleges with good results. In view of the majority of the patients in rural and suburban communities, not all patients need referral to higher centers.

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“…Pancreatic anastomosis leakage remains a major cause of postoperative morbidity after PD, and it contributes significantly to operative mortality. Lin et al [2] retrospectively reviewed 1891 patients undergoing PD, 216 of those patients (11.4%) developed a postoperative pancreaticocutaneous fistula. Hosotani et al [16], reviewed 161 patients who had undergone PD and reported a fistula rate of 11% (17/161), finding that pancreaticojejunostomy anastomotic technique, pancreatic texture and pancreatic duct size were substantial risk factors for pancreatic leakage after PD.…”

Section: Discussionmentioning

confidence: 99%

“…PD nowadays represents a complex procedure and a challenge for the surgeon. Recently, the operative mortality rate after PD has significantly declined, while the incidence of postoperative morbidity remains high, from 40%-50% [1][2][3][4][5][6], and a recent series of 650 operations demonstrated a 30-day mortality of 1.4% [7]. The improved mortality is related to improve general management surgeon expertise and higher volume of procedures being performed in a hospital [5].…”

Section: Introductionmentioning

confidence: 99%

Analysis of procedure-related complications after pancreatodoudenectomy

et al. 2010

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Purpose To analyze the procedure-related complications after pancreaticoduodenctomy (PD) and their risk factors.Methods One hundred twenty-six patients underwent pancreatoduodenectomy for diseases at region of pancreatic head were reviewed retrospectively. ResultsThe overall surgical morbidity was 40.5% (51/126). Ten (7.9%) of 51 patients were identified as having pancreatic leakage, others included delayed gastric emptying (8.7%, 11), abdominal infection and abscess (7.9%, 10), abdominal bleeding (5.6%, 7), wound infection (4.8%, 6), wound dehiscence (2.4%, 3), biliary fistula (1.6%, 2) and operative death (1.6%, 2). Other postoperative complications were lung inflammation (3.9%, 5) and newly developed diabetes mellitus (2.3%, 3). Age (>60 years), coexisting diabetes mellitus, small main pancreatic duct (≤0.5 cm), and surgeon's experience (<10 patients within 5 years) were demonstrated to be independent risk factors by both univariate and multivariate analysis (p < 0.01).Conclusions Old patients with coexisting diabetes mellitus and small main pancreatic duct undergo pancreatoduodenectomy by a less experienced surgeon may be at high risk of procedure-related complications.

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Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula

Cited by 338 publications

References 25 publications

Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan

Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan

Pancreaticoduodenectomy in a Government Medical College—Should We Proceed!!!

Analysis of procedure-related complications after pancreatodoudenectomy

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