Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy

McMillan, Matthew T.; Christein, John D.; Callery, Mark P.; Behrman, Stephen W.; Drebin, Jeffrey A.; Hollis, Robert H.; Kent, Tara S.; Miller, Benjamin; Sprys, Michael H.; Watkins, Ammara A.; Strasberg, Steven M.; Vollmer, Charles M.

doi:10.1016/j.surg.2015.10.028

Cited by 99 publications

(73 citation statements)

References 22 publications

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“…We analyzed a large cohort of patients from two consociated, high-volume centers sharing a standardized technique for PJ with an overall CR-POPF rate of 16.8%, which is consistent with rates reported by other high-volume Institutions. [25][26][27] The main finding of the present study confirms what we have previously reported, 23 that PE sutures are independently associated with a lower incidence of CR-POPF. This potential protective effect against CR-POPF is virtually maintained across all CR-POPF risk zones, but the negligible risk group, in which the POPF incidence is nil.…”

Section: Discussionsupporting

confidence: 92%

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Andrianello

Marchegiani

Malleo

et al. 2018

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Section: Discussionsupporting

confidence: 92%

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Andrianello

Marchegiani

Malleo

et al. 2018

HPB

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“…On the contrary, patients undergoing distal pancreatectomies typically have higher CR-POPF rates than those undergoing pancreaticoduodenectomies [20][21][22] -this was not found in our study. The clinically relevant POPF rate amongst our patients with distal pancreatectomies was actually slightly lower compared to patients with pancreaticoduodenectomies (17.2% and 32.2%, respectively).…”

Section: Hpbcontrasting

confidence: 84%

“…15 It has been suggested that the overall complication burden and postoperative pancreatic fistula rate experienced by patients undergoing pancreatic resection is likely underestimated. 20 We believe that our clinically relevant POPF rate of nearly 29% may be a fair reflection of modern surgical practice that incorporates a large portion of patients undergoing pancreatic resection for diagnoses other than pancreatic cancer.…”

Section: Hpbmentioning

confidence: 93%

Pasireotide is not effective in reducing the development of postoperative pancreatic fistula

Young

Sung

Lee

et al. 2018

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“…Pancreatic resection continues to be a procedure that has significant morbidity and measurable mortality 6, 21, 22 . Pancreatic fistula, leak, and abscess (referred to in this study as pancreatic leak), are a group of complications related to the anastomosis (pancreaticoduodenectomy) or closure (distal pancreatectomy) of the pancreatic remnant.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Postoperative Pancreatic Fistula Versus the Cost of Pasireotide

et al. 2017

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Objective The objective of this study was to determine the costs of clinically significant postoperative pancreatic fistula (POPF), and to evaluate the cost-effectiveness of routine pasireotide use. Summary Background Data We recently completed a prospective randomized trial that demonstrated an 11.7% absolute risk reduction of clinically significant POPF with use of perioperative pasireotide in patients undergoing pancreaticoduodenectomy or distal pancreatectomy (POPF: pasireotide (n=152), 9% vs. placebo (n=148), 21%; p=0.006). Methods An institutional modeling system was utilized to obtain total direct cost data from the 300 patients included in the trial. This system identified direct costs of hospitalization, physician fees, laboratory tests, invasive procedures, outpatient encounters, and readmissions. Total direct costs were calculated from the index admission to 90 days after resection. Costs were converted to Medicare dollars. Results Clinically significant POPF occurred in 45 of the 300 randomized patients (15%). The mean total cost for all patients was $23,350 ($8,017–$202,494). The mean cost for those who developed clinically significant POPF was $39,615 ($13,770–$202,494) vs. $20,480 ($8,017–$62,941) for those who did not (p=0.001). The mean cost of pasireotide within the treatment group (n=152) was $3,316 ($273–$3,826). The mean cost was lower in the pasireotide (n=152) group than the placebo (n=148) group; however this did not reach statistical significance (pasireotide, $22,774 vs. placebo, $23,941: p=0.571). Conclusions The development of POPF nearly doubled the total cost of pancreatic resection. In this randomized trial, the routine use of pasireotide significantly reduced the occurrence of POPF without increasing the overall cost of care.

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Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy

Cited by 99 publications

References 22 publications

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Pasireotide is not effective in reducing the development of postoperative pancreatic fistula

The Cost of Postoperative Pancreatic Fistula Versus the Cost of Pasireotide

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