Abstract
Background. After pancreaticoduodenectomy (PD), pancreatic fistulas (PF) are a frequent complication. Infusions may compromise anastomotic integrity. This retrospective analysis evaluated associations between intraoperative fluid excess and PF. Methods. Data on perioperative parameters including age, sex, laboratory findings, histology, infusions, surgery time, and occurrence of grade B/C PF was collected from all PD with pancreaticojejunostomy (PJ) performed in our department from 12/2011 till 02/2015. The glomerular filtration rate (GFR), infusion rate, and the ratio of both and its association with PF were calculated. ROC analysis was employed to identify a threshold. Results. Complete datasets were available for 83 of 86 consecutive cases. Median age was 66 years (34–84; 60% male), GFR was 93 mL/min (IQR 78–113), and surgery time was 259 min (IQR 217–307). Intraoperatively, 13.6 mL/min (7–31) was infused. In total, n = 18 (21%) PF occurred. When the infusion : GFR ratio exceeded 0.15, PF increased from 11% to 34% (p = 0.0157). No significant association was detected for any of the other parameters. Conclusions. This analysis demonstrates for the first time an association between intraoperative fluid excess and PF after PD with PJ even in patients with normal renal function. A carefully patient-adopted fluid management with due regard to renal function may help to prevent postoperative PF.
Highlights
In high volume centers, partial pancreaticoduodenectomy (PD) can be performed with acceptable morbidity and mortality [1]
The amount of postoperative infusions had no effect on occurrence of pancreatic fistulas (Table 1)
Except for creatinine, glomerular filtration rate (GFR), and postoperative infusion of colloids, no statistical differences were identified between patients with or without pancreatic fistulas (Table 1)
Summary
Partial pancreaticoduodenectomy (PD) can be performed with acceptable morbidity and mortality [1]. While the outcome is clearly associated with surgeon and center experience, the rate of pancreatic fistulas seems not to drop below a certain level [2, 3]. Even after thousands of PD, highly experienced surgeons in highvolume centers report an almost constant or even increasing rate of pancreatic fistulas [2]. Isolation of the pancreaticojejunostomy (PJ) using dual-loop reconstruction has been discussed as possible intervention to decrease the rate of pancreatic fistulas but seems not to be superior to single-loop reconstruction [1]. This retrospective analysis evaluated associations between intraoperative fluid excess and PF. This analysis demonstrates for the first time an association between intraoperative fluid excess and PF after PD with PJ even in patients with normal renal function. A carefully patient-adopted fluid management with due regard to renal function may help to prevent postoperative PF
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