Independent Risk Factors Of Pancreatic Fistula Research Articles

Pancreatic fistula and biliary fistula after laparoscopic pancreatoduodenectomy: 500 patients at a single institution.

Pancreatic fistula (PF) and biliary fistula (BF) are two major leakage complications after pancreatoduodenectomy (PD). The aim of this study is to investigate the risk factors of PF and BF after laparoscopic PD (LPD). We conducted a retrospective analysis of 500 patients who underwent LPD from 1 April 2015 to 31 March 2020. Clinical data from patients were analysed using multivariate logistic regression analysis. PF occurred in 86 (17.2%) patients. Univariate and multivariate analysis indicated that the soft texture of the pancreas (P = 0.001) was the independent risk factor for PF. BF occurred in 32 (6.4%) patients. Univariate and multivariate analysis indicated that history of cardiovascular disease (P < 0.001), surgical time (P = 0.005), pre-operative CA125 (P = 0.036) and pre-operative total bilirubin (P = 0.044) were independent risk factors for BF. The texture of the pancreas was an independent risk factor for PF after LPD, which was consistent with the literatures. In addition, history of cardiovascular disease, surgical time, pre-operative CA125 and pre-operative total bilirubin were new independent risk factors for BF after LPD. Therefore, patients with high-risk factors of BF should be informed that they are at a high risk for this complication.

Risk Factors and Management of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: Single-center Experience.

Pancreatic fistula (PF) remains the most frequent complication after pancreaticoduodenectomy (PD). This study was undertaken to explore the risk factors of postoperative PF following PD and discuss the management of PF in our center. A single-center respective study, involving 241 patients who underwent PD between September 2015 and June 2018, was conducted. Differences in the demographic data, preoperative, intraoperative and postoperative variables between the group with PF [International Study Group on Pancreatic Surgery (ISGPS) grade B/C] and the group without PF (no PF and ISGPS grade BL) were evaluated. The diagnosis and grading of PF were in strict accordance with ISGPS. Risk factors were analyzed by univariate analysis and multivariate logistic regression analysis. The results showed that postoperative PF occurred in 50 (20.7%) of the patients; 25 (10.4%) patients had a PF type BL, 46 (19.1%) patients developed a PF type B and 4 (1.6%) had a PF type C. Univariate analysis showed that fasting blood glucose (P=0.02), pancreatic texture (P&lt; 0.001) and pancreatic duct diameter (P=0.01) were correlated with PF. Multivariate logistic regression analysis identified one independent risk factor for postoperative PF: soft pancreatic texture (OR=3.251, P=0.002). Among the cases, there were three postoperative deaths, giving a 60-day hospital mortality rate of 1.2% (3/241), and the mortality related to PF was 4.0% (2/50). One of the patients died from multiple organ failure caused by postoperative abdominal hemorrhage. In conclusion, soft pancreatic texture is an independent risk factor for PF. Surgeons should be well aware of this risk factor when performing a PD.

Pancreatic attenuation on computed tomography predicts pancreatic fistula after pancreaticoduodenectomy

BackgroundSome parameters using preoperative computed tomography (CT) have been evaluated to predict the development of pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The present retrospective study evaluated the predictive value of pancreatic attenuation for PF after PD. MethodsA retrospective review was conducted of the patients who underwent PD between January 2010 and December 2014. The pancreatic attenuation was measured in unenhanced preoperative CT images. Pre- and intraoperative variables were analyzed for the risk of PF after PD. ResultsOf the 346 consecutive patients, PF occurred in 116 (34%). The pancreatic attenuation was significantly greater in patients with PF than in those without PF (median, 40.0 vs. 33.3 Hounsfield units [HU], P < 0.001). A multivariate analysis showed that a pancreatic attenuation ≥30.0 HU (odds ratio [OR], 3.72; P < 0.001), a body mass index ≥25.0 kg/m2 (OR, 3.67; P < 0.001) and a diameter of the main pancreatic duct <3.0 mm (OR, 1.84; P = 0.034) were independent risk factors for PF after PD. ConclusionThe degree of pancreatic attenuation on preoperative CT images was significantly associated with PF, and a pancreatic attenuation ≥30.0 HU was an independent risk factor of PF after PD.

Visceral adipose tissue and skeletal muscle index distribution predicts development of severe pancreatic fistula after pancreaticoduodenectomy

Background: Pancreatic fistula (PF) development after pancreaticoduodenectomy (PD) remains a life-threatening complication. In this study, we investigated the impact of body composition on PF development after PD. Methods: Ninety-nine patients with pancreatic and extrahepatic biliary malignancy following PD who were treated in our department between 2006 and 2016 were enrolled. Univariate and multivariate analyses were performed to investigate variables associated with PF. The 2005 international pancreatic fistula criteria were used to define PF. Results: The median age of subjects was 72 years and 69 patients were male. The overall mortality and morbidity rates were 1.0% and 36.4%, respectively. The severe PF (grade B, C) was developed in 30 patients, of which 25 patients (25.3%) were classified as grade B in and 5patients (5%) were classified as grade C. Univariate analysis identified that body mass index ≥25 kg/m2 (p=0.032), vesicle adipose tissue area (VATA)/skeletal muscle index (SMI) ≥2.0 (p=0.002), main pancreatic duct diameter ≤3 mm (p<0.001) and drain amylase (Amy) at postoperative day (POD) 1 ≥5000 U/L (p<0.001) were significantly associated with severe PF after PD. Multivariate analysis indicated that VATA/SMI ≥2.0 (p=0.009), pancreatic duct diameter ≤3 mm (p=0.003) and drain Amy at POD1 ≥5000 U/L (p=0.032) were independent risk factors for PF. Conclusion: Preoperative assessment of VATA/SMI has an important role in predicting PF development after PD.

Transection using a reinforced stapler reduces the incidence of pancreatic fistula after distal pancreatectomy

Purpose: The appropriate procedure for closure of the remnant pancreatic stump in distal pancreatectomy (DP) remains unresolved. The purpose of this study was to compare the incidence of pancreatic fistula (PF) among the 3 methods, and to determine the risk factors for PF after DP. Methods: Between July 2009 and December 2016, 66 patients underwent pancreatic stump closure with 1 of 3 methods: the clamp-crushing method (n = 26), ultrasonic scissors (n = 18), and a reinforced stapler (n = 22). Results: There were significant differences in the incidence of PF (clamp-crushing method [38%] vs ultrasonic scissors [61%] vs reinforced stapler [9%], p< 0.001), and in the incidence of postoperative intra-abdominal hemorrhage (clamp-crushing method [0%] vs ultrasonic scissors [17%] vs reinforced stapler [0%] p = 0.047). A multivariate analysis revealed that intraoperative blood loss (≥605 mL), pancreatic thickness (≥11 mm), and the stump closure method were independent risk factors for PF after DP (p = 0.03, p = 0.001, p=0.018 respectively). Conclusion: The use of a reinforced stapler for the transection of the pancreas can reduce PF after DP. Intraoperative blood loss (≥ 605 mL), pancreatic thickness (≥ 11 mm), and the stump closure method remained as independent risk factors for PF after DP.

A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure.

A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP. One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density. Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037). Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use.

Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience.

Laparoscopic distal pancreatectomy (LDP) is a treatment option for benign and borderline pancreatic tumors. However, pancreatic fistula (PF) remains a significant morbidity, contributing to the length of hospital stay and overall costs. In a consecutive series of 143 patients at a single institution, the predictive factors associated with PF after LDP were identified. A retrospective study of patients who had undergone LDP between January 2003 and December 2013 was conducted. Patient demographic data and clinicopathological parameters were analyzed to evaluate their correlation with the incidence of PF. Among the 143 patients, the indications for surgery were benign disease in 117 (82%) and malignant tumors in 26 (18%). PF occurred in 25 (17%) patients, 10 (40%) of whom had clinically significant (grade B) PF. No grade C PF was observed. Multivariable analysis showed that pancreatic thickness was a significant predictive factor for PF (P < 0.001). A 12-mm cutoff value was based on the median pancreatic thickness in this series. Pancreatic texture alone was not a significant risk factor (P = 0.30); however, it became significant in patients with pancreatic thickness exceeding 12 mm (P = 0.005). Pancreatic thickness exceeding 12 mm significantly increases the likelihood of PF after LDP. Pancreatic texture alone is not an independent risk factor for PF, but when combined with a thick parenchyma (>12 mm), a soft pancreas is predictive of PF.

Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association

BackgroundsA pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma. MethodsUsing a survey tool, clinical data of 1325 patients undergoing a PD for ductal adenocarcinoma at 37 institutions, between January 2004 and December 2009, were collected. Peri-operative risk factors associated with PF and its association with morbidity and mortality were assessed. Morbidity and PF were graded according to the ISGPF (International Study group for pancreatic fistula) definition and the Dindo–Clavien classification. ResultsOverall PF, mortality, morbidity and relaparotomy rates were 14.3%, 3.8%, 54.4% and 11.7%, respectively. PF occurred more frequently after a pancreaticojejunostomy (PJ) compared with a pancreaticogastrostomy (PG) (16.8% vs. 10.4%; P = 0.0012). Independent risk factors for PF by multivariate analysis were absence of pre-operative diabetes (P = 0.0014), PJ reconstruction (P = 0.0035), soft pancreatic parenchyma (P < 0.0001) and low-volume centre (P = 0.0286). Clinically relevant PF (grade B and C) and severe complications (Dindo–Clavien grade IIIB, IV, V) were significantly more frequent after PJ than PG (71.6% vs. 28.3%; P = 0.030 and 24.8% vs. 19.1%; P = 0.015, respectively). Overall mortality and relaparotomy rates were similar after PG and PJ. ConclusionsA soft pancreatic parenchyma, the absence of pre-operative diabetes, PJ and low-volume centre are independent risk factors for PF after PD for ductal adenocarcinoma. A significantly higher incidence and clinical severity of PF are associated with PJ.

Surgical outcomes of distal pancreatectomy.

Most efforts to minimize pancreatic fistula after distal pancreatectomy (DP) have been focused on techniques of pancreatic transection and management of the pancreatic remnant. However, an ideal method of handling remnant pancreas after resection does not exist. This study evaluates surgical outcome of DP and describes how to reduce pancreatic fistula (PF) after DP. From March 1999 to May 2011, 142 DPs were performed at Ajou University Medical Center. The rate of pancreatic leak was 23.2% (33/142); grade A (n=18), grade B (n=15), and grade C (n=0). The remnant pancreas was managed by stapler in 44 patients (31.0%), suture in 45 (31.7%), and stapler with suture in 53 (37.3%). The morbidity and mortality rates were 38.0% and 0%. In patients who underwent surgery for extrapancreatic disease, the rate of PF was 50% (25/50). It was significantly higher than that (11.9%) in those with pancreatic disease (p = 0.003). Among closure methods for the remnant pancreas, the stapler with suture method reduced postoperative PF. In those with pancreatic disease, the PF rate after stapler with suture was significantly lower than that with stapler or suture alone. Surgery for extrapancreatic disease is an independent risk factor for PF after DP. Of the methods of handling pancreatic remnants, the stapler with suture method by an experienced hepatobiliary surgeon decreased the risk of PF.