The pancreatic juice length in the stent tube as the predicting factor of clinical relevant postoperative pancreatic fistula after pancreaticoduodenectomy.

Hangyan Wang,Ming Tao,Dianrong Xiu

doi:10.1097/md.0000000000008451

Abstract

Several risk factors for pancreatic fistula had been widely reported, but there was no research focusing on the exocrine output of remnant gland.During the study period of January 2015 to September 2016, 82 patients accepted pancreaticoduodenectomy (PD, end-to-end dunking pancreaticojejunostomy with internal stent tube). All the data were collected, including preoperative medical status, operative course, final pathology, gland texture, pancreatic duct diameter, size of the stent, length of pancreatic juice in the stent tube, width of the pancreatic stump, diameter of the jejunum and the status of postoperative pancreatic fistula (POPF). POPF was defined according to International Study Group of Pancreatic Fistula criteria.The diameter of pancreatic duct in the POPF group was significantly smaller than that in the group without POPF (1.99 vs 2.90 mm, P = .000). The length of pancreatic juice in the stent tube in the POPF group was significantly longer than that in the group without POPF (18.04 vs 6.92 cm, P = .014). There were more pancreatic ductal adenocarcinoma cases and hard glands in the group without POPF. The length of pancreatic juice in the clinically relevant postoperative pancreatic fistula (CR-POPF) group was significantly longer than that in the grade A group (32.4 vs 9.21 cm, P = .000). Multivariate analysis identified gland texture and length of pancreatic juice as independent predictors for pancreatic fistula. Multivariate analysis also identified the length of pancreatic juice as an independent predictor for CR-POPF.The length of pancreatic juice in the stent tube might be a useful predictive factor of POPF after PD, especially for CR-POPF.

Highlights

The development in surgical technique and postoperative management technology have reduced the rates of mortality in the patients undergoing pancreaticoduodenectomy (PD), while the rate of clinically relevant postoperative pancreatic fistula (CR-POPF) continued to persist at approximately 15%.[1,2,3,4]
After the diagnosis of POPF, we still want to know whether the POPF will develop toward a complicated fistula that needs specific intervention or whether it will heal spontaneously without further intervention
How can one identify the patient with a pancreatic fistula that will probably develop complications, as opposed to the patient who can be safely discharged with a drain and treated on an outpatient basis? How to distinguish the “high risk” and “low risk” patients as early as possible and to make decision of taking critical treatment for high risk patients and avoiding over medicalization for low risk patients? The essential question for the management of POPF still is whether one can, in the early period after pancreatic surgery, distinguish CR-POPF, which need more intervention, from transient pancreatic fistula.[17]

Summary

Introduction

The development in surgical technique and postoperative management technology have reduced the rates of mortality in the patients undergoing pancreaticoduodenectomy (PD), while the rate of clinically relevant postoperative pancreatic fistula (CR-POPF) continued to persist at approximately 15%.[1,2,3,4] The CR-POPF is one of the most important life-threatening complications that couldEditor: Kelvin Ng. The development in surgical technique and postoperative management technology have reduced the rates of mortality in the patients undergoing pancreaticoduodenectomy (PD), while the rate of clinically relevant postoperative pancreatic fistula (CR-POPF) continued to persist at approximately 15%.[1,2,3,4] The CR-POPF is one of the most important life-threatening complications that could

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