Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage

Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Komagome, Masahiko; Shin, Nobuhiro; Cho, Narihiro; Ishida, Takashi; Ozawa, Fumiaki; Hashimoto, Daijo

doi:10.1007/s00534-009-0248-6

Cited by 91 publications

(72 citation statements)

References 25 publications

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“…Ten parameters were assessed in the hematoxylin-eosin stained frozen section samples: pancreatic duct size, periductal, interlobular and intralobular fibrosis, inter- and intralobular fat content, edema, signs of chronic and acute inflammation. The ratio of the main pancreatic duct to the diameter of the short axis of the pancreatic body (MPD index) and the cut surface area of the resection margin were also calculated [28]. A scoring system was developed in order to differentiate between low-risk and high-risk pancreatic tissue – the lower the score the higher the risk of POPF (table 1).…”

Section: Methodsmentioning

confidence: 99%

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

Belyaev¹,

Münding

Herzog³

et al. 2011

Pancreatology

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Section: Methodsmentioning

confidence: 99%

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

Belyaev¹,

Münding

Herzog³

et al. 2011

Pancreatology

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“…Despite recent advancements in surgical procedures and post‐operative management techniques, pancreatic fistula remains the most common post‐operative complication after PD, even at high‐volume centres 18, 19. Therefore, most surgeons strive to decrease the occurrence of POPF and research has been conducted on the various risk factors that significantly influence POPF.…”

Section: Discussionmentioning

confidence: 99%

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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BackgroundMany studies have reported factors affecting pancreatic leakage after pancreaticoduodenectomy (PD), but there have been few reports on surgeon workload and post‐operative pancreatic fistula (POPF). This study was conducted to explore whether a surgeon's workload during PD impacts the occurrence of POPF.MethodsWe retrospectively analysed 270 consecutive patients who underwent PD between January 2008 and June 2013 by a single experienced surgeon. These patients were divided into those who underwent PD entirely by a single operator (group 1) and those who received reconstructions by other operators (group 2). Duct‐to‐mucosa pancreaticojejunostomy was performed on all patients. The International Study Group on Pancreatic Fistula criteria were used to define POPF.ResultsThere were 157 patients (58.1%) in group 1 and 113 patients (41.9%) in group 2. The post‐operative morbidity rate was comparable between the two groups (55.4% versus 52.2%; P = 0.603), but the clinical pancreatic fistula (grade B/C) rate was significantly different (10.8% versus 2.7%; P = 0.011). The overall post‐operative mortality was one patient (0.4%). Significant associations were found between clinical pancreatic fistulas and soft pancreas texture (P = 0.021), preoperative serum albumin level ≤3.5 g/dL (P = 0.012), other pathology besides pancreatic cancer (P = 0.027) and a single‐operator procedure (P = 0.019). A multivariate logistic regression analysis revealed that a single operator (odds ratio: 4.2, P = 0.029) was a significant predictive risk factor for clinically relevant POPF.ConclusionDividing the surgeon's workload in PD is associated with lower rates of POPF.

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“…In the past several years, increased intraoperative blood loss has been recognized as a predictive factor for PF [26,27]. Because an adequate blood supply to the stump of the pancreas is critical to wound healing, the next step leading to a successful anastomosis [28], postoperative infusion planning must be supported.…”

Section: Reducing Problms Of Anastomosis With the Pancreas Stumpmentioning

confidence: 99%

The Best Choice to Achieve Zero Complications after Pancreatoduodenectomy

Osada¹,

Imai²,

Sasaki³

et al. 2011

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Pancreatoduodenectomy (PD) has been performed commonly, but the occurrence of pancreatic fistula (PF) is a critical trigger of complications, which are potentially life threatening, and is also associated with markedly prolonged hospitalization. Many techniques have been proposed for connecting the pancreatic stump with the gastrointestinal tract, stomach vs. jejunum, etc. Among the risk factors for PF, such as general patient factors or disease-related factors, the most important is the texture of the remnant pancreas. Surgical technique might be one improvable aspect that can reduce the pancreatic leakage rate, therefore; various methods of managing the pancreatic remnant have been studied. Methods of reconstruction between the remnant pancreas and the intestine include end-to-side with/without duct-to-mucosa anastomosis or end-to-end invagination styles, has been argued. Here, we review several trials for safety and methods of treating the pancreatic stump after PD, and demonstrate our experiences.

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Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage

Abstract: The MPD index obtained from preoperative MDCT can be a reliable predictor of POPF after PD.

Cited by 91 publications

References 25 publications

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

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

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

The Best Choice to Achieve Zero Complications after Pancreatoduodenectomy

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