Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors

Fuks, David; Piessen, Guillaume; Huet, Emmanuel; Tavernier, M; Zerbib, Philippe; Michot, F; Scotté, Michel; Triboulet, Jean–Pierre; Mariette, C.; Chiche, Laurence; Salamé, E; Ségol, P; Pruvot, François‐René; Mauvais, F.; Roman, Horace; Verhaeghe, Pierre; Régimbeau, Jean-Marc

doi:10.1016/j.amjsurg.2008.03.004

Cited by 262 publications

(223 citation statements)

References 27 publications

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“…This invasive procedure is associated with high mortality. 6,10,11 However, other studies have shown that completion pancreatectomy can be performed with a relatively good outcome (ie, low mortality), and the investigators argue that, in patients needing relaparotomy, the operation should be performed as soon as possible. 3,8,12,13 Primary catheter drainage is a less invasive alternative to relaparotomy; it reduces tissue damage and the systemic inflammatory response otherwise induced by surgical stress in these already critically ill patients.…”

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confidence: 99%

“…3,14 In another group of critically ill patients with pancreatic disease (infected necrotizing pancreatitis), standard treatment is now a minimally invasive step-up approach consisting of percutaneous catheter drainage as a first step to be followed by surgical intervention if patients do not improve clinically. 15 Several studies have shown a wide range (15%-50%) in the percentage of patients with pancreatic fistula treated with relaparotomy 6,[16][17][18][19][20][21] ; however, relaparotomy might be needed in only a small selection of these patients. 2,22,23 The aim of the present study was to evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as the primary treatment for severe pancreatic fistula after pancreatoduodenectomy in 9 centers of the Dutch Pancreatic Cancer Group.…”

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confidence: 99%

“…5 Major causes for mortality in these patients are multiple-organ failure and postpancreatectomy hemorrhage as a direct result of the pancreatic fistula. 6 Consensus on the optimal treatment strategy of clinically relevant pancreatic fistula is lacking. [7][8][9] For decades, treatment was through direct relaparotomy.…”

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confidence: 99%

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Management of Severe Pancreatic Fistula After Pancreatoduodenectomy

et al. 2017

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IMPORTANCEPostoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking.OBJECTIVE To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula after pancreatoduodenectomy. DESIGN, SETTING, AND PARTICIPANTSA multicenter, retrospective, propensity-matched cohort study was conducted in 9 centers of the Dutch Pancreatic Cancer Group from January 1, 2005, to September 30, 2013. From a cohort of 2196 consecutive patients who underwent pancreatoduodenectomy, 309 patients with severe pancreatic fistula were included. Propensity score matching (based on sex, age, comorbidity, disease severity, and previous reinterventions) was used to minimize selection bias. Data analysis was performed from January to July 2016.EXPOSURES First intervention for pancreatic fistula: catheter drainage or relaparotomy.MAIN OUTCOMES AND MEASURES Primary end point was in-hospital mortality; secondary end points included new-onset organ failure. RESULTSOf the 309 patients included in the analysis, 209 (67.6%) were men, and mean (SD) age was 64.6 (10.1) years. Overall in-hospital mortality was 17.8% (55 patients): 227 patients (73.5%) underwent primary catheter drainage and 82 patients (26.5%) underwent primary relaparotomy. Primary catheter drainage was successful (ie, survival without relaparotomy) in 175 patients (77.1%). With propensity score matching, 64 patients undergoing primary relaparotomy were matched to 64 patients undergoing primary catheter drainage. Mortality was lower after catheter drainage (14.1% vs 35.9%; P = .007; risk ratio, 0.39; 95% CI, 0.20-0.76). The rate of new-onset single-organ failure (4.7% vs 20.3%; P = .007; risk ratio, 0.15; 95% CI, 0.03-0.60) and new-onset multiple-organ failure (15.6% vs 39.1%; P = .008; risk ratio, 0.40; 95% CI, 0.20-0.77) were also lower after primary catheter drainage. CONCLUSIONS AND RELEVANCEIn this propensity-matched cohort, catheter drainage as first intervention for severe pancreatic fistula after pancreatoduodenectomy was associated with a better clinical outcome, including lower mortality, compared with primary relaparotomy.

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Management of Severe Pancreatic Fistula After Pancreatoduodenectomy

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“…The overall re-laparotomy rate has decreased, indicating that many complications can be managed by non-operative means. Once the operative approach is decided the degree of destruction and inflammation in the retro-peritoneum probably plays the major role in determining the operative 383 November 27, 2010|Volume 2|Issue 11| WJGS|www.wjgnet.com [6] , 1996 458 NA NA 17 NA 4 (24) van Berge Henegouwen et al [7] , 1997 269 29 (11)/NA 21 8 8 (38) 0 Fuks et al [8] , procedure for correcting the leaking pancreaticojejunal anastomosis. At the present time, the use of CP is under debate whereas conservative management is thought to be as a salvage solution equally efficient to CP.…”

Section: Management Controversiesmentioning

confidence: 99%

“…In order to determine risk factors for PF grade C, Fuks et al [8] studied 680 patients who underwent PD in 5 digestive surgery departments in the northwest region of France. PF was defined according to the Bassi definition.…”

Section: Fistula Grade C In Several Studiesmentioning

confidence: 99%

An ongoing dispute in the management of severe pancreatic fistula: Pancreatospleenectomy or not?

Dellaportas¹

2010

WJGS

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The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery. Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery. However, leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection. Various strategies have been employed in order to manage pancreatic fistula. Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment. A Medline search was performed, with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C. Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death. Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures, while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions. There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery. Completion pancreatectomy is reserved for patients not improving with conventional measures.

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Omental Roll-up Technique Decreases Pancreatic Fistula–or Does It?

Lillemoe¹

2012

Arch Surg

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Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors

Cited by 262 publications

References 27 publications

Management of Severe Pancreatic Fistula After Pancreatoduodenectomy

Management of Severe Pancreatic Fistula After Pancreatoduodenectomy

An ongoing dispute in the management of severe pancreatic fistula: Pancreatospleenectomy or not?

Omental Roll-up Technique Decreases Pancreatic Fistula–or Does It?

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