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Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula

Published on Dec 1, 2004in Journal of Gastrointestinal Surgery2.69
· DOI :10.1016/j.gassur.2004.09.044
John W. Lin7
Estimated H-index: 7
(Johns Hopkins University),
John L. Cameron119
Estimated H-index: 119
(Johns Hopkins University)
+ 2 AuthorsKeith D. Lillemoe96
Estimated H-index: 96
(IU: Indiana University)
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Abstract
A significant fraction of patients undergoing pancreaticoduodenectomy develop a postoperative pancreaticocutaneous fistula. To identify risk factors for this complication and to delineate its impact on patient outcomes, we conducted a retrospective review of 1891 patients undergoing pancreaticoduodenectomy between 1981 and 2002. Overall, 216 patients (11.4%) developed a postoperative pancreaticocutaneous fistula. In univariate analysis, gender, coronary disease, diabetes mellitus, operative times, blood loss, radical lymphadenectomy, gland texture, and specimen pathology correlated with fistula rates. In a multivariate model, however, only gland texture and coronary disease were statistically predictive. A soft gland was associated with a 22.6% fistula rate, a 20.4-fold increase in fistula risk over those patients with a medium or firm gland (95% confidence interval, 4.7–90.9). No patient with a firm gland developed a fistula. Although 30-day postoperative mortality was not different between those patients with and those without fistula (1.4% versus 1.5%), the mean length of stay was longer (26.0 days versus 13.2 days) and the rates of certain complications were increased in those patients with fistula. In this single-institution experience, pancreaticocutaneous fistula was most strongly predicted by pancreatic texture. Choice of anastomotic technique did not correlate with fistula rates. Pancreaticocutaneous fistula increases postoperative length of stay and morbidity but was not directly associated with increased postoperative mortality.
  • References (27)
  • Citations (261)
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References27
Newest
#1Gerard V. Aranha (LUC: Loyola University Chicago)H-Index: 34
#2Pamela J. Hodul (LUC: Loyola University Chicago)H-Index: 20
Last.Steven Creech (LUC: Loyola University Chicago)H-Index: 3
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#1Taylor A. Sohn (Johns Hopkins University)H-Index: 39
#2Charles J. Yeo (Johns Hopkins University)H-Index: 125
Last.Keith D. Lillemoe (Johns Hopkins University)H-Index: 96
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#1RonnieTung-PingPoon (HKU: University of Hong Kong)H-Index: 87
#2Siu Hung Lo (HKU: University of Hong Kong)H-Index: 1
Last.John Wong (HKU: University of Hong Kong)H-Index: 58
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#1Kevin C. Conlon (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 58
#2Daniel Labow (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 22
Last.Murray F. Brennan (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 140
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#1Claudio Bassi (University of Verona)H-Index: 79
#2Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 71
Last.Paolo Pederzoli (University of Verona)H-Index: 66
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#2Katiuscha Merath (The Ohio State University Wexner Medical Center)H-Index: 5
Last.Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 7
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#1Mengyi Lao (ZJU: Zhejiang University)H-Index: 1
#2Xiao-Zhen Zhang (ZJU: Zhejiang University)
Last.Tingbo Liang (ZJU: Zhejiang University)H-Index: 24
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#1Michele Mazza (UniSR: Vita-Salute San Raffaele University)
#2Stefano Crippa (UniSR: Vita-Salute San Raffaele University)H-Index: 41
Last.Massimo FalconiH-Index: 71
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#1Lisbi Rivas (WashU: Washington University in St. Louis)H-Index: 1
#2Lisbi Rivas (WashU: Washington University in St. Louis)
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#1Jerry Jiang (UCLA: University of California, Los Angeles)
#2Alex Upfill-Brown (UCLA: University of California, Los Angeles)
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