Risk Factors for Clinical Pancreatic Fistula After Distal Pancreatectomy: Analysis of Consecutive 100 Patients

Yoshioka, Ryuji; Saiura, Akio; Koga, Rintaro; Seki, Makoto; Kishi, Yoji; Morimura, Ryo; Yamamoto, Junji; Yamaguchi, Toshiharu

doi:10.1007/s00268-009-0300-3

Cited by 98 publications

(74 citation statements)

References 30 publications

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“…3 The morbidity, though, has not fallen significantly and reported rates in literature vary between 22 and 57%. 4,5 The bulk of this morbidity consists of post operative pancreatic fistulas (POPF), delayed gastric emptying (DGE) and post pancreatectomy hemorrhage (PPH). PDs are being done in hospitals of Armed Forces Medical Services for a long time now and there is a need to look at the outcomes of this surgery in our hospitals.…”

Section: Introductionmentioning

confidence: 99%

Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital

Jakhmola

Kumar

2014

Medical Journal Armed Forces India

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MorbidityPostoperative pancreatic fistula Delayed gastric emptying Mortality Outcomes a b s t r a c t Background: Pancreaticoduodenectomy is a formidable surgery and was associated with high morbidity and mortality. Though the mortality rates have steadily improved, morbidity continues to be high. There is lack of published data on outcomes following pancreaticoduodenectomy in Armed Forces hospitals. The aim of this study was to analyze the short term outcomes at our center and to compare it with the published literature.Methods: A retrospective review of prospectively maintained data base was done. Preoperative, intraoperative and postoperative data was analyzed with emphasis on the morbidity and mortality rates. Follow up data was analyzed to look at disease recurrence.Results: Between Jan 2008 and March 2014, 69 patients underwent Whipple's pancreaticoduodenectomy with a median age of 64 years. All had a malignant etiology with periampullary carcinoma being the commonest (42%). Overall, intra-abdominal complications occurred in 46% of patients which included postoperative pancreatic fistula (20%) and delayed gastric emptying (24%). The mortality rate for the whole was 11% which reduced to 8% in the second half of the study. Conclusion:The short term outcomes at our center were comparable to those in published literature. The mortality rates showed a decreasing trend with time.

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Section: Introductionmentioning

confidence: 99%

Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital

Jakhmola

Kumar

2014

Medical Journal Armed Forces India

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“…Pancreatic fistulae are more frequent after enucleation or left-sided pancreatectomy, but their consequences are more severe after pancreaticoduodenectomy, due to infectious or haemorrhagic complications. They occur globally in 3-60% of cases, depending on the definition (Pannegeon et al 2006;Yoshioka et al 2010;Zhao et al 2011). Most of them are asymptomatic and no additional treatment is necessary.…”

Section: Treatment 241 Surgerymentioning

confidence: 99%

Diagnosis and Treatment of Insulinomas in the Adults

Vezzosi¹,

Bennet²,

Maïza³

et al. 2011

Basic and Clinical Endocrinology Up-to-Date

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“…In addition, PF is associated with additional complications such as intra-abdominal abscess or hemorrhage, and leads to a prolonged hospital stay [2] . Some factors have been reported to predispose patients to the development of PF, including the surgical technique, a soft or normal pancreas, pancreatic thickness, age, obesity, and extended lymphadenectomy [1][2][3][4][5][6] . A review of published results for DP in PubMed Central from January 1998 to October 2014 was conducted using the following terms: "distal pancreatectomy", "pancreas", and "randomized study".…”

Section: Introductionmentioning

confidence: 99%

Perioperative management of distal pancreatectomy

Fujino¹

2015

WJG

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Recent advances in surgical techniques and perioperative management have markedly reduced operative morbidity after distal pancreatectomy (DP). However, some questions remain regarding the protocol for the perioperative management of DP, in particular, with regard to the development of pancreatic fistula (PF). A review of DP was therefore conducted in order to standardize the management of patients for a favorable outcome. Overall, operative technique and perioperative management emerged as two critical factors contributing to favorable outcome in DP patients. As for the operative method, surgical and closure techniques exhibited differences in outcome. Laparoscopic DP generally yields more favorable perioperative outcomes compared to open DP, and is applicable for benign tumors and some ductal carcinomas of the pancreas. Robotic DP is also available for safe pancreatic surgery. En bloc celiac axis resection offers a high R0 resection rate and potentially allows for some local control in the case of advanced pancreatic cancer. Following resection, staple closure was not found to reduce the rate of PF when compared to hand-sewn closure. In addition, ultrasonic dissection devices, fibrin glue sealing, and staple closure with mesh reinforcement were shown to significantly reduce PF, although there was some bias in these studies. In perioperative management, both preoperative and postoperative treatment affected outcome. First, preoperative endoscopic pancreatic stenting may be an effective prophylactic measure against fistula development following DP in selected patients. Second, in postoperative management, a multifactorial approach including prophylactic antibiotics improved high surgical site infection rates following complex hepato-pancreatobiliary surgery. Furthermore, although conflicting results have been reported, somatostatin analogues should be administered selectively to patients considered to have a high risk for PF. Finally, careful drain management also facilitates a favorable outcome in patients with PF after DP. The results of the review indicate that laparoscopic DP coupled with perioperative management influences outcome in DP patients. Core tip: Perioperative management of distal pancreatectomy has been reviewed in order to standardize management for a favorable outcome in these patients.Fujino Y. Perioperative management of distal pancreatectomy.

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Risk Factors for Clinical Pancreatic Fistula After Distal Pancreatectomy: Analysis of Consecutive 100 Patients

Abstract: Age < 65 years, not ligating the MPD, and extended lymphadenectomy are independent risk factors for clinical PF.

Cited by 98 publications

References 30 publications

Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital

Whipple's pancreaticoduodenectomy: Outcomes at a tertiary care hospital

Diagnosis and Treatment of Insulinomas in the Adults

Perioperative management of distal pancreatectomy

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