Histomorphological Features of the Pancreatic Remnant as Independent Risk Factors for Postoperative Pancreatic Fistula: A Matched-Pairs Analysis

Belyaev, Orlin; Münding, Johanna; Herzog, Torsten; Suelberg, Dominique; Tannapfel, Andrea; Schmidt, Wolfgang E.; Mueller, Christophe A.; Uhl, Waldemar

doi:10.1159/000332587

Cited by 60 publications

(64 citation statements)

References 33 publications

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“…Three studies derived a predictive model for POPF based on preoperative risk factors [8,13,17]. Intraoperative risk factors were used by one study to derive a predictive model of POPF [12]. Two studies built a predictive model for POPF in accordance with postoperative risk factors [11,18].…”

Section: Resultsmentioning

confidence: 99%

“…In terms of geography, three articles were from Asia [8,17,18] and four articles were from Europe [10][11][12][13].…”

Section: Resultsmentioning

confidence: 99%

“…The median number of events about postoperative pancreatic fistula was 69 (IQR 25∼197). Five studies reported the number of events on postoperative pancreatic fistula grades based on ISGPF [5,8,11,12,18], the medium number of events on grade A 47 (IQR 6 to 76), grade B 17 (IQR 10 to 94), and grade C 8 (IQR 5 to 25). Two studies did not report the number of events on postoperative pancreatic fistula grades [10,17].…”

Section: Number Of Patients and Postoperative Pancreatic Fistulamentioning

confidence: 99%

“…Three risk prediction models (43 %) were developed in which the number of events per variable was <10 [10,12,13]. Overall, the medium number of events per variable was 10 (IQR 7 to 39, range 5 to 175).…”

Section: Sample Sizementioning

confidence: 99%

“…Many risk factors for POPF have been identified, such as gender [8], body mass index (BMI) [9,10], status of the pancreatic parenchyma [11], diameter of the main pancreatic duct (MPD) [12], and kind of disease [13]. These risk factors lead to use some special techniques or perioperative precautions to minimize POPF rates [5,14,15].…”

Section: Introductionmentioning

confidence: 99%

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Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

Zhang

Guo

et al. 2016

Indian J Surg

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Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, modelbuilding strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42 %), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71 %) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86 %) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula.

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Section: Resultsmentioning

confidence: 99%

“…In terms of geography, three articles were from Asia [8,17,18] and four articles were from Europe [10][11][12][13].…”

Section: Resultsmentioning

confidence: 99%

Section: Number Of Patients and Postoperative Pancreatic Fistulamentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

Zhang

Guo

et al. 2016

Indian J Surg

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Central pancreatectomy prevents postoperative diabetes

Klotz

Schilling

Kuner

et al. 2022

J Hepato Biliary Pancreat

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Background: Central pancreatectomy (CP) can be performed as an alternative surgical approach to distal pancreatectomy (DP) in the treatment of benign or low-grade malignant lesions located in the neck and body of the pancreas, aiming to reduce loss of parenchyma and therefore organ failure. The objective of this study was to evaluate the short-and long-term outcome of CP in comparison to DP. Methods: Patients who received CP in a large tertiary care pancreatic surgery center between 2001 and 2020 were identified from a prospectively maintained database and compared via propensity score matching with patients receiving DP during the same time period. Perioperative rate of complications and long-term outcome of pancreatic endocrine and exocrine function were evaluated. Results: One hundred and seven patients undergoing open CP were compared to 107 patients with open DP. No significant difference in rates or severity of most surgical complications could be found including postoperative pancreatic fistula, intraabdominal fluid collection, delayed gastric emptying and wound infection.However, patients receiving CP had a significantly higher risk of grade C postpancreatectomy hemorrhage (PPH) (CP: 10 patients, 9.3% versus DP: 1 patient, 0.9%; p = .0019). Perioperative mortality was comparable. Long-term follow-up of 60 matched pairs revealed significantly less patients with new-onset diabetes after CP (eight patients, 13.3%) compared to DP (22 patients, 36.7%, p = .0056). Conclusion:CP offers an improved endocrine long-term outcome at the expense of a higher risk of PPH without increased perioperative mortality. As evidence on this parenchyma sparing surgical technique is sparse, more prospective data are needed.

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Facing the surgeon's nightmare: Incidence and management of postoperative pancreatic fistulas grade C after pancreaticoduodenectomy based on the updated definition of the International Study Group of Pancreatic Surgery (ISGPS)

Luu

Krasemann

Fahlbusch

et al. 2020

J Hepato Biliary Pancreat

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Background Postoperative pancreatic fistulas (POPF) grade C represent a rare but feared complication following pancreaticoduodenectomy (PD). They can contribute significantly to postoperative morbidity and mortality. Methods We performed a retrospective chart review for all patients who had undergone pancreatic head resection between 2007 and 2016 to identify those who suffered from POPF grade C according to the updated definition of the International Study Group of Pancreatic Surgery (ISGPS). Results A total of 722 patients underwent PD. Twenty‐three patients (3.19%) developed a POPF grade C. Cardiovascular diseases, soft pancreatic texture and main pancreatic duct diameter were identified as risk factors (P < .05). Reoperation was necessary in all affected patients on postoperative day 12 ± 9 on average. Mortality was significantly associated with POPF grade C (P < .05) being present in 39.1% (9/23). Conclusions POPF grade C after PD remains a serious complication with a high level of morbidity and mortality. Surgical treatment is the sole curative therapy and thus the treatment of choice.

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Histomorphological Features of the Pancreatic Remnant as Independent Risk Factors for Postoperative Pancreatic Fistula: A Matched-Pairs Analysis

Cited by 60 publications

References 33 publications

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

Central pancreatectomy prevents postoperative diabetes

Facing the surgeon's nightmare: Incidence and management of postoperative pancreatic fistulas grade C after pancreaticoduodenectomy based on the updated definition of the International Study Group of Pancreatic Surgery (ISGPS)

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