The Characterization and Prediction of ISGPF Grade C Fistulas Following Pancreatoduodenectomy

Abstract

This global study represents the largest analysis of grade C POPFs following PD. It describes the severe burden that grade C POPFs incur on patients, with high rates of reoperation and infection, while also potentially worsening overall survival by causing death and delay/omission of adjuvant therapy. Additionally, aggressive clinical management for these POPFs did not improve or worsen 90-day mortality. Predictive tools developed through these data may provide value in managing this difficult complication.

Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification

“…18 This study's clinical care protocol can guide patient management, but it should not supplant surgeon judgment. 18 This study's clinical care protocol can guide patient management, but it should not supplant surgeon judgment.…”

“…17 This prognostic tool is based on the presence of certain risk factors for the development of CR-POPF: soft/normal pancreatic parenchyma, high-risk disease pathology [all pathologies other than pancreatic ductal adenocarcinoma (PDAC) or pancreatitis], small pancreatic duct diameter, and elevated intraoperative blood loss. 18 Risk Assessment: Identifying Patients Eligible for Early Drain Removal Per protocol specifications, DFA was measured on POD 1 for moderate/high risk patients, as these patients received drains intraoperatively. Calculated scores are then discretized and assigned to one of four risk zones: negligible risk, 0 points; low risk, 1 to 2 points; moderate risk, 3 to 6 points; or high risk, 7 to 10 points.…”

“…The median years of experience as an attending surgeon was 14 (IQR [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], and the median career PD volume as an attending surgeon was 265.5 (IQR 98.3-734.8). Soft pancreatic parenchyma was encountered 58.8% of the time.…”

Management of Severe Pancreatic Fistula After Pancreatoduodenectomy

“…Several small, retrospective studies describe the general treatment of pancreatic fistula. 6,[16][17][18][19][20][21]35 Most of these studies indicate that minimally invasive catheter drainage should be the treatment of choice in these patients. However, the studies also report a relaparotomy rate varying from 15% to 50%, suggesting at least some hesitation to treat pancreatic fistula in a minimally invasive approach.…”

Effect of Neoadjuvant Nab-Paclitaxel plus Gemcitabine Therapy on Overall Survival in Patients with Borderline Resectable Pancreatic Cancer: A Prospective Multicenter Phase II Trial (NAC-GA Trial)

“…The secondary endpoints were recurrence-free survival from the first day of protocol therapy, safety of the protocol therapy (adverse effects), morbidity (equal to more than grade I of the Clavien Dindo classification) [11] , response rate, disease control rate, preoperative/postoperative tumor marker (CA 19-9, CEA), rate of normalization, reduction rate of the maximum standardized uptake value on positron emission tomography-computed tomography (limited to institutions where positron emission tomography-computed tomography was available), chemotherapeutic effect (grade based on Evans' classification), resection rate, R0 resection rate, surgical data(operative time, blood loss, transfusion, postoperative hospital day), overall morbidity rates (reoperation, rate of readmission, mortality), rate of patients undergoing postoperative adjuvant therapy (entry rate, completion rate), dose intensity , quality of life regarding fatigue and malaise assessed by the questionnaire of FACIT-F (Japanese version), and peripheral sensory neuropathy assessed by the questionnaire of FACT/GOG-NTX subscale (version 4; Japanese version) and the Patient Neurotoxicity Questionnaire (PNQ). Sixty patients were included in the study.…”