Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture

Eshmuminov, Dilmurodjon; Schneider, Marcel; Tschuor, Christoph; Raptis, Dimitri Aristotle; Kambakamba, Patryk; Muller, Xavier; Lesurtel, Mickaël; Clavien, Pierre‐Alain

doi:10.1016/j.hpb.2018.04.003

Cited by 104 publications

(91 citation statements)

References 121 publications

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“…Postoperative pancreatic fistulas (POPF) are present in 11%‐16% of cases. They account for most of the complications and usually are treated conservatively …”

Section: Introductionmentioning

confidence: 99%

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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“…Postoperative pancreatic fistulas (POPF) are present in 11%‐16% of cases. They account for most of the complications and usually are treated conservatively …”

Section: Introductionmentioning

confidence: 99%

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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“…Of all the risk factors for POPF, a soft consistency of the pancreatic parenchyma is one of the factors that is the most widely accepted [30,31,[37][38][39][40][41]. Eschmuminov et al [33] analyzed 22,376 patients included in 122 studies using the updated 2016 ISGPS (International Study Group Pancreatic Fistula) definition. They reported that the POPF rate was significantly higher in soft pancreas than in hard pancreas (RR, 4.4, 3.3 to 6,1; p < 0.001; n = 6393).…”

Section: Discussionmentioning

confidence: 99%

“…Several reasons have been proposed to explain the higher frequency of POPF in soft pancreas. Firstly, soft pancreas is likely to have a pancreatic duct with an average diameter less than 3 mm [33]. Secondly, soft pancreas has a higher exocrine function than hard pancreas and thus may produce more enzyme-rich pancreatic juice [31,42].…”

Section: Discussionmentioning

confidence: 99%

“…Of them, numerous studies consistently indicated that pancreatic texture is the most contributory predictor of POPF [28,[30][31][32]. Several meta-analyses reported that patients with soft pancreas have the significantly higher incidence of POPF than did those with hard pancreas [32,33]. Soft pancreas has poor suture holding capacity (SHC) and is frequently associated with parenchymal tearing arising from technical difficulties [31,34].…”

Section: Introductionmentioning

confidence: 99%

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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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“…This systematic review was conducted according to the PRISMA statement . A systematic literature search of the databases Cochrane, Embase, Medline, PubMed, and Scopus was conducted on 23rd of May, 2017, including only publications in English.…”

Section: Methodsmentioning

confidence: 99%

Perfusion settings and additives in liver normothermic machine perfusion with red blood cells as oxygen carrier. A systematic review of human and porcine perfusion protocols

et al. 2018

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Liver machine perfusion (MP) at normothermic temperature (NMP) is a promising way to preserve and evaluate extended criteria donor livers. Currently, no consensus exists in methodology and perfusion protocols. Here, the authors performed a systematic literature search to identify human and porcine studies reporting on liver NMP with red blood cells. A qualitative synthesis was performed concerning technical aspects of MP, fluid composition, gas supply, and liver positioning. Thirty-seven publications including 11 human and 26 porcine studies were considered for qualitative synthesis. Control mode, pressure, flow, perfusate additives, and targeted blood gas parameters varied across human as well as porcine studies. For future analyses, it is advisable to report flow adjusted to liver weight and exact pressure parameters including mean, systolic, and diastolic pressure. Parenteral nutrition and insulin addition was common. Parenteral nutrition included amino acids and/or glucose without lipids. Taurocholic acid derivatives were used as bile flow promoters. However, short-term human NMP without taurocholic acid derivatives seems to be possible. This finding is relevant due to the lack of clinical grade bile salts. Near physiological oxygen tension in the perfusate is doable by adjusting gas flows, while blood gas parameters regulation needs more detailed description.

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Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture

Cited by 104 publications

References 121 publications

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)

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)

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

Perfusion settings and additives in liver normothermic machine perfusion with red blood cells as oxygen carrier. A systematic review of human and porcine perfusion protocols

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