Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy

Zhang, H; Zhu, Feng; Shen, Ming; Tian, Rui; Shi, Changcheng; Wang, X; Jiang, Jingmei; Hu, Jun; Wang, M; Qin, Renyi

doi:10.1002/bjs.9653

Cited by 124 publications

(97 citation statements)

References 72 publications

(93 reference statements)

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“…36 % (Tag 30; [6]). Eine aktuelle Metaanalyse mit 37 Studien und über 5200 Patienten zeigt, dass der Staplerverschluss sowie die Anlage einer Anastomose auf die Pankreasschnittfläche eine geringere POPF-Rate aufweisen, allerdings zeigen sich auch hier die Probleme der methodologischen Heterogenität sowie der angewandten POPF-Definition, die v. a. in älteren Studien nicht einheitlich ist [28].…”

Section: Distale Pankreatektomieunclassified

Management der postoperativen Pankreasfistel

Hackert

Büchler

2015

Chirurg

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The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication varies between 3 % after pancreatic head resection and up to 35 % following distal pancreatectomy. In 2005, the international definition of postoperative pancreatic fistula was standardized according to the approach of the International Study Group of Pancreatic Surgery (ISGPS) including an A-C grading system of the severity. Consequently, results from different studies have become comparable and the historically reported fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, fistula-associated complications and management of postoperative pancreatic fistula.

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Section: Distale Pankreatektomieunclassified

Management der postoperativen Pankreasfistel

Hackert

Büchler

2015

Chirurg

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“…But none of techniques have proven to be superior to other techniques. 11,12,13 Until 2005, the exact incidence of POPF was not known due to lack of objective definition defining POPF.…”

Section: Discussionmentioning

confidence: 99%

Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

et al. 2017

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Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.

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“…The morbidity rate after pancreatic surgery still remains high in the range of 15% to 65%, although mortality has decreased to less than 5% due to recent advances in surgical techniques and perioperative management (1)(2)(3)(4)(5)(6)(7). In particular, pancreatic fistula is one of the most severe postoperative complications after pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

Kitahata¹,

Kawai²,

Yamaue³

2016

Transl. Gastroenterol. Hepatol.

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Pancreatic fistula is one of severe postoperative complications that occur after pancreatic surgery, such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). Because pancreatic fistula is associated with a higher incidence of life-threatening complications. In order to evaluate procedure or postoperative management to reduce pancreatic fistula after pancreatic surgery, we summarized some randomized controlled trials (RCTs) regarding pancreaticoenterostomy during PD, pancreatic duct stent during PD, procedure to resect pancreatic parenchyma during DP, and somatostatin and somatostatin analogues after pancreatic surgery.At first, we reviewed nine RCTs to compare pancreaticogastrostomy (PG) with pancreaticojejunostomy (PJ) during PD. Next, we reviewed five RCTs, to evaluate the impact of pancreatic duct stent during PD. Regarding DP, we reviewed six RCTs to evaluate appropriate procedure to reduce pancreatic fistula after DP. Finally, we reviewed eight RCTs to evaluate the impact of somatostatin and somatostatin analogues after pancreatic surgery to reduce pancreatic fistula. The best way to prevent pancreatic fistula after pancreatic surgery remains still controversial. However, several RCTs clarify a useful procedure to reduce in reducing the incidence of pancreatic fistula after pancreatic surgery. Further RCTs to study innovative approaches remain a high priority for pancreatic surgeons to prevent pancreatic fistula after pancreatic surgery.

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Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy

Cited by 124 publications

References 72 publications

Management der postoperativen Pankreasfistel

Management der postoperativen Pankreasfistel

Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

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