Risk factors for postoperative pancreatic fistula

Ke, Zunxiang; Cui, Jing; Hu, Nianqi; Yang, Zhiyong; Chen, Hengyu; Hu, Jin; Wang, Chunyou; Wu, Heshui; Nie, Xiuquan; Xiong, Jie

doi:10.1097/md.0000000000012151

Cited by 41 publications

(22 citation statements)

References 52 publications

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“…A total of 37 studies 10,11,[28][29][30]33,34,37,39,44,45,[48][49][50][51][52][53]55,[58][59][60][61][62][63][64]72,74,75,77,81,83,87,87,[123][124][125] with 14,471 patients investigated MPD diameter as a risk factor for CR-POPF, applying different cut-offs. Irrespective of the cut-off, duct diameter was associated with CR-POPF (OR 3.14, 95% CI 2.53-3.90, P < 0.01) (Fig.…”

Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

“…Twelve studies 10,44,55,59,63,72,75,77,81,83,123,124 including 4660 patients classified MPD diameter of r 3mm as a high risk for CR-POPF development (OR 2.99, 95% CI 2.17-4.13, P < 0.01). Another 20 studies 11,29,30,33,37,39,44,45,[48][49][50][51]58,61,62,64,74,79,87,125 with 9067 patients used MPD diameter of ≤3 mm as the high-risk cut-off, although the results were comparable (OR 3.66, 95% CI 2.62-5.12, P < 0.01).…”

Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

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A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

et al. 2021

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Objective: The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD). Summary Background Data: Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking. Methods: A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort. Results: Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62–5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively (P < 0.001). Conclusion: For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results.

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Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

et al. 2021

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“…One of the most important factors of morbidity and mortality following PD is the incidence of POPF. Many previous studies have reported several risk factors in PD, such as gender (male)[19], BMI > 25 kg/m 2[20] , anastomotic method[6,21], external stent[22], fasting blood glucose level < 108.0 mg/dL[23], etc . However, the most reliable consensus risk factors for POPF after PD are small pancreatic duct (≤ 3 mm) and soft pancreas[6,21,23-28], which reflect the possibility that adequate anastomosis of the pancreatic duct and active exocrine function are deeply involved in the development of POPF.…”

Section: Pancreaticoduodenectomymentioning

confidence: 99%

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

Kawaida¹,

Kono²,

Hosomura³

et al. 2019

WJG

139

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Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.

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“…The modern incidence of clinically significant pancreatic fistulae as defined by the International Study Group of Pancreatic Surgery is variable and dependent on numerous factors and patient characteristics. Rates in the literature range from 5% to greater than 30% [13][14][15][16][17]. Utilizing organ-space surgical infection as a surrogate may underestimate the true incidence of pancreatic fistula but is nonetheless a useful metric to consider.…”

Section: Discussionmentioning

confidence: 99%

Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients

et al. 2020

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Background: While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are currently unknown. Methods: ACS-NSQIP was reviewed for all non-traumatic pancreatic resections (DPdistal pancreatectomy, PDpancreaticoduodenectomy, or TP-total pancreatectomy) in patients with pancreatico-biliary or duodenal-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher's exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. Results: Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p < 0.001) for emergent vs. elective operations. Emergent operations resulted in increased transfusion rates (47.6% vs. 23.4%, p < 0.001), return to OR (14.0% vs. 5.6%, p < 0.001), organ-space infection (14.6 vs. 10.5, p = 0.002), unplanned intubation (9.% vs. 4.1%, p < 0.001), pneumonia (9.6% vs. 4.2%, p < 0.001), length of stay (14 days vs. 8 days, p < 0.001), and discharge to skilled facility (31.1% vs. 13.9%). These differences persisted when stratified by pancreatic resection type. The 30-day operative mortality was higher in the emergent group (9.4%vs. 2.7%, p < 0.001) and highest for emergent TP (20%). Conclusion: Emergent pancreatic resection is markedly uncommon in the setting of neoplastic disease. Although these operations result in increased morbidity and mortality compared to elective resections, they can be life-saving in specific circumstances. The results of this large series of modern era national data may assist surgeons as well as patients and their families in making critical decisions in select cases of acutely complicated neoplastic disease.

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Risk factors for postoperative pancreatic fistula

Cited by 41 publications

References 52 publications

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients

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