Postoperative pancreatic fistula: a review of traditional and emerging concepts

Nahm, Christopher B.; Connor, Saxon; Samra, Jaswinder S.; Mittal, Anubhav

doi:10.2147/ceg.s120217

Cited by 156 publications

(144 citation statements)

References 129 publications

(130 reference statements)

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“…POPF remains a complex problem in a subset of patients due to the lack of understanding of the underlying pathophysiology of this complication and the significant variability in the recovery process. 34 Our study demonstrated that patients who suffered cardiac and respiratory complications had an increased rate of POPF compared to those who did not experience perioperative cardiorespiratory events. This supports pre-existing literature and the hypothesis that patients with a lower anaerobic threshold had a greater incidence of POPF and major intra-abdominal abscesses.…”

Section: Discussionmentioning

confidence: 54%

“…A correlation between increased cardiopulmonary complications and POPF was also identified in this study. POPF remains a complex problem in a subset of patients due to the lack of understanding of the underlying pathophysiology of this complication and the significant variability in the recovery process . Our study demonstrated that patients who suffered cardiac and respiratory complications had an increased rate of POPF compared to those who did not experience perioperative cardiorespiratory events.…”

Section: Discussionmentioning

confidence: 62%

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Preoperative cardiac and respiratory investigations do not predict cardio‐respiratory complications after pancreatectomy

Ashrafizadeh

Mehta

Nahm

et al. 2019

ANZ Journal of Surgery

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Background The process of undergoing a pancreatic resection places a patient under notable physiologic strain throughout the perioperative journey, with well recognized risks of postoperative cardiopulmonary complications. Preoperative preparations and screening often incorporate a barrage of testing, including electrocardiograms, transthoracic echocardiography, chest X‐rays and spirometric evaluations. However, the current literature does not demonstrate whether these common tests provide any predictive correlation with postoperative cardiopulmonary complications. This retrospective study is structured to identify complications in post‐pancreatic resection patients and assess for a predictive correlation with preoperative test results. Methods A retrospective analysis of all patients having undergone a pancreatic resection at a single tertiary centre, between 2014 and 2016. The inpatient medical records were reviewed for 30‐day postoperative complications, including acute myocardial infarction, cardiac dysrhythmia, pulmonary embolism, pneumonia or pleural effusions. The results of routine preoperative diagnostic tests and complication rates were analysed. Results A total of 244 patients, median age of 66 years (range 18–88 years) were included in the study. Of these, 11 patients experienced a cardiac complication and 16 patients experienced a respiratory complication. Among those who experienced cardiac events, only two patients had abnormalities in their preoperative electrocardiograms. Patients who sustained a cardiac or respiratory event did not have any evidence of abnormality in their preoperative transthoracic echocardiography or respiratory investigations, respectively. Conclusion Despite the recommendation that high‐risk procedures such as pancreatic resections warrant thorough, routine, preoperative cardiac and respiratory investigation, a more functional preoperative assessment should be considered to stratify and predict postoperative outcomes.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 62%

Preoperative cardiac and respiratory investigations do not predict cardio‐respiratory complications after pancreatectomy

Ashrafizadeh

Mehta

Nahm

et al. 2019

ANZ Journal of Surgery

Self Cite

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“…Generally, POPF is first identified on 1-3 days after pancreatic surgery [46][47][48]. Our study showed that the time (POD 2-3) when POPF is peaked coincides with the time (POD 2-3) when penicillin G maximizes fibrogenesis in the pancreas.…”

Section: Discussionmentioning

confidence: 54%

A Novel Way of Preventing Postoperative Pancreatic Fistula by Directly Injecting Profibrogenic Materials into the Pancreatic Parenchyma

Lee

Hong

Kim

et al. 2020

IJMS

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This paper aims to validate if intrapancreatic injection of penicillin G can enhance hardness and suture holding capacity (SHC) of the pancreas through prompting the fibrosis process. Soft pancreatic texture is constantly mentioned as one of the most contributory predictors of postoperative pancreatic fistula (POPF). Soft pancreas has poor SHC and higher incidence of parenchymal tearing, frequently leading to POPF. From a library of 114 antibiotic compounds, we identified that penicillin G substantially enhanced pancreatic hardness and SHC in experimental mice. Specifically, we injected penicillin G directly into the pancreas. On determined dates, we measured the pancreatic hardness and SHC, respectively, and performed molecular and histological examinations for estimation of the degree of fibrosis. The intrapancreatic injection of penicillin G activated human pancreatic stellate cells (HPSCs) to produce various fibrotic materials such as transforming growth factor-β1 (TGF-β1) and metalloproteinases-2. The pancreatic hardness and SHC were increased to the maximum at the second day after injection and then it gradually subsided demonstrating its reversibility. Pretreatment of mice with SB431542, an inhibitor of the TGF-β1 receptor, before injecting penicillin G intrapancreatically, significantly abrogated the increase of both pancreatic hardness and SHC caused by penicillin G. This suggested that penicillin G promotes pancreatic fibrosis through the TGF-β1 signaling pathway. Intrapancreatic injection of penicillin G promotes pancreatic hardness and SHC by enhancing pancreatic fibrosis. We thus think that penicillin G could be utilized to prevent and minimize POPF, after validating its actual effectiveness and safety by further studies.

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“…There is one potential explanation for this finding. Compared to the early 2000s when the operation in this analysis was performed, there has been notable progress in the pancreatic anastomosis procedure and in both intra-and postoperative management [22]. These recent advances may account for the discrepancy between the POPF rate in our study and those of our recent surgical results.…”

Section: Discussionmentioning

confidence: 62%

Efficacy and safety of preoperative 5-fluorouracil, cisplatin, and mitomycin C in combination with radiotherapy in patients with resectable and borderline resectable pancreatic cancer: a long-term follow-up study

et al. 2019

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Background: We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC). Methods: This retrospective study investigated the clinicopathological features and > 5-year survival of patients with T3/T4 PDAC who underwent NACRT at our institute between 2003 and 2012. Results: Seventeen resectable and eight borderline resectable patients were included. The protocol treatment completion and resection rates were 92.0% and 68.0%, respectively. Two patients failed to complete chemotherapy owing to cholangitis or anorexia. Common grade 3 toxicities included anorexia (12%), neutropenia (4%), thrombocytopenia (4%), anemia (4%), and leukopenia (12%). Pathologically negative margins were achieved in 94.1% of patients who underwent pancreatectomy. Pathological response according to Evans' classification was grade IIA in 10 patients (58.8%), IIB in 5 patients (29.4%), and IV in 2 patients (11.8%). Postoperative pancreatic fistulas were observed in four patients (23.5%), delayed gastric emptying in one patient (5.9%), and other operative morbidities in four patients (23.5%). The 1-, 2-, 5-, and 10-year overall survival rates were 73.9%, 60.9%, 60.9%, and 39.1%, respectively (median follow-up period, 80.3 months). Conclusions: NACRT is tolerable and beneficial for resectable/borderline resectable PDAC, even in the long-term.

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Postoperative pancreatic fistula: a review of traditional and emerging concepts

Cited by 156 publications

References 129 publications

Preoperative cardiac and respiratory investigations do not predict cardio‐respiratory complications after pancreatectomy

Preoperative cardiac and respiratory investigations do not predict cardio‐respiratory complications after pancreatectomy

A Novel Way of Preventing Postoperative Pancreatic Fistula by Directly Injecting Profibrogenic Materials into the Pancreatic Parenchyma

Efficacy and safety of preoperative 5-fluorouracil, cisplatin, and mitomycin C in combination with radiotherapy in patients with resectable and borderline resectable pancreatic cancer: a long-term follow-up study

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