Cephalic duodenopancreatectomy resection: technique, morbidity and mortality

Lada, Paul Eduardo; Janikow, Christian; Sánchez, Miguel Calabuig; Massa, Michela; Caballero, Fernando Granados; Menso, Nicolas; Peluaga, J. Martínez; Mariot, Daniela; Nicollini, Francisco Florez; Gramática, Luis

doi:10.1016/j.hpb.2019.03.306

Cited by 1 publication

(1 citation statement)

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“…Similar to the reports of other authors [50][51][52][53][54][55], our study found an important postoperative morbidity rate of 32%, where the most frequent complications are as follows: pancreatic fistula (in 17 patients, representing 16.2% of the operated-on cases); delayed gastric emptying; intra-abdominal collections; hemorrhage; and general complications. The postoperative pancreatic fistula occurrence rate from our study falls as an average value in the wide range of fistula rates reported by other authors (5-30%, up to 73%, with large variability between studies) [1][2][3][4][5][6][7].…”

Section: Discussionsupporting

confidence: 91%

Pancreaticogastrostomy versus Pancreaticojejunostomy and the Proposal of a New Postoperative Pancreatic Fistula Risk Score

Mastalier,

Cauni,

Tihon

et al. 2023

JCM

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Despite the substantial decrease in mortality rates following a pancreaticoduodenectomy to less than 5%, morbidity rates remain significant, reaching even 73%. Postoperative pancreatic fistula is one of the most frequent major complications and is significantly associated with other complications, including patient death. Currently, there is no consensus regarding the ideal type of pancreatic anastomosis, as the question of the choice between a pancreaticogastrostomy and pancreaticojejunostomy is still open. Furthermore, worldwide implementation of an ideal pancreatic fistula risk prediction score is missing. Our study found several significant predictive factors for the postoperative occurrence of fistulas, such as the soft consistency of the pancreas, non-dilated Wirsung duct, important intraoperative blood loss, other perioperative complications, preoperative patient hypoalbuminemia, and patient weight loss. Our study also revealed that for patients who exhibit fistula risk factors, pancreaticogastrostomy demonstrates a significantly lower pancreatic fistula rate than pancreaticojejunostomy. The occurrence of pancreatic fistulas has been significantly associated with the development of other postoperative major complications, and patient death. As the current pancreatic fistula risk scores proposed by various authors have not been consensually validated, we propose a simple, easy-to-use, and sensitive score for the risk prediction of postoperative pancreatic fistula occurrence based on important predictors from statistical analyses that have also been found to be significant by most of the reported studies. The new pancreatic fistula risk score proposed by us could be extremely useful for improved therapeutic management of cephalic pancreaticoduodenectomy patients.

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