Risk factors and outcomes of postoperative pancreatic fistula after pancreatico-duodenectomy: an audit of 532 consecutive cases

Abstract

BackgroundPancreatic fistula (PF) remains the most challenging complication after pancreaticoduodenectomy (PD). The purpose of this study was to identify the risk factors of PF and delineate its impact on patient outcomes.MethodsWe retrospectively reviewed clinical data of 532 patients who underwent PD and divided them into PF group and no PF group. Risk factors and outcomes of PF following PD were examined.ResultsPF was found in 65 (12.2%) cases, of whom 11 were classified into ISGPF grade A, 42 grade B, and 12 grade C. Clinically serious postoperative complications in the PF versus no PF group were mortality, abdominal bleeding, bile leak, intra-abdominal abscess and pneumonia. Univariate and multivariate analysis showed that blood loss ≥ 500 ml, pancreatic duct diameter ≤ 3 mm and pancreaticojejunostomy type were independent risk factors of PF after PD.ConclusionsBlood loss ≥ 500 ml, pancreatic duct diameter ≤ 3 mm and pancreatico-jejunostomy type were independent risk factors of PF after PD. PF was related with higher mortality rate, longer hospital stay, and other complications.

Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours

“…Polanco et al . and Fu and colleagues both found that higher EBL and smaller pancreatic duct diameter were associated with a higher POPF rate, based on robotic and open pancreaticoduodenectomies. In addition, male sex and operating time over 180 min were independent determinants of grade B/C POPF.…”

The Neutrophil-to-Lymphocyte Ratio Predicts Malignant Potential in Intraductal Papillary Mucinous Neoplasms

“…Despite developments in anesthesia and surgery, the mortality of patients undergoing pancreaticoduodenectomy is about 5 %, owing to life-threatening complications mainly caused by pancreatic fistulas. [28][29][30][31] Supportive tools are necessary, especially for IPMN patients who are at poor risk for surgery, including those with chronic heart failure, chronic kidney disease, and severe liver cirrhosis. The current study demonstrated that NLR is significantly higher in patients with a malignant component than in patients with IPMA.…”

The occurrence of Enterococcus faecium and faecalis Is significantly associated With anastomotic leakage After pancreaticoduodenectomy

“…A small number of patients undergoing PD are due to benign reasons, for example, intraductal papillary mucinous neoplasm. Anastomotic leakage and the subsequent pancreatic fistula are the most common surgical complications after a PD (3). Known risk factors of leakage have previously been identified including the diameter of the pancreatic duct, a soft pancreas texture, ischemia, perioperative bleeding, and body mass index (BMI) (3,4).…”

“…Anastomotic leakage and the subsequent pancreatic fistula are the most common surgical complications after a PD (3). Known risk factors of leakage have previously been identified including the diameter of the pancreatic duct, a soft pancreas texture, ischemia, perioperative bleeding, and body mass index (BMI) (3,4). In addition, a prospectively validated clinical score that accurately predicts pancreatic fistulas after PD has been published (5).…”