Abstract
Introduction: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a major source of morbidity and mortality after pancreatoduodenectomy (PD). The primary aim of this study was to investigate changes in the management and outcomes of CR-POPF at our institution, a high-volume centre. The secondary aim was to investigate whether there was any difference in outcome after completion pancreatectomy or washout only if laparotomy was required for CR-POPF. Method: All cases of CR-POPF at our institution between 2005-2020 were reviewed. Trends in patient demographics, operative factors, management a of CR-POPF and outcomes were investigated across three five-year time periods. Results: There were 102 cases of CR-POPF after a total of 1,342 PDs at our institution, an overall rate of 7.6%. Over the study period, the proportion of Grade C POPF reduced (p<0.001) and an increasing number of CR-POPF patients were managed conservatively (p=0.014). Both the median length of stay (p<0.001) and 90-day mortality rate reduced significantly over the study period. There were eight laparotomies performed for CR-POPF during the study period, including five completion pancreatectomies. There was no difference in outcomes between those managed with completion pancreatectomy compared to washout only. Conclusions: Survival and length of stay after CR-POPF have improved significantly since POPF was first defined in 2005. Patients are increasingly managed with surgical drains and discharged earlier. More research is required to ascertain whether there is any difference between completion pancreatectomy and washout in the management of CR-POPF. This may require a multicentre collaborative study to achieve adequate statistical power.Tabled 1EP02D-0962005-2009 (n=451)2010-2014 (n=352)2015-2019 (n=539)pPOPF Grade<0.001B12 (52)11 (32)37 (82)-C11 (48)23 (68)8 (18)-Management0.014Conservative12 (52)14 (41)33 (73)-Percutaneous Intervention11 (48)16 (47)8 (18)-Surgical Intervention0 (0)4 (12)4 (8)-Length of Stay30 (23-41)29 (22-46)18 (13-27)<0.00190-day Mortality6 (26)6 (18)2 (4)0.035 Open table in a new tab
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