Icons / Logo / Facebook Created with Sketch. Icons / Logo / Google Created with Sketch. Icons / Logo / ORCID Created with Sketch. Branding/Logomark minus Citation Combined Shape Icon/Bookmark-empty Icon/Copy Icon/Collection Icon/Close Copy 7 no author result Created with Sketch. Icon/Back Created with Sketch. Match!

Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors.

Published on Jun 1, 2009in American Journal of Surgery 2.20
· DOI :10.1016/j.amjsurg.2008.03.004
David Fuks28
Estimated H-index: 28
,
Guillaume Piessen24
Estimated H-index: 24
+ 14 AuthorsJean Marc Regimbeau41
Estimated H-index: 41
Cite
Abstract
Abstract Background Pancreatic fistula (PF) is one of the most common postoperative complications of pancreatoduodenectomy (PD). A recent International Study Group on Pancreatic Fistula (ISGPF) definition grades the severity of PF according to the clinical impact on the patient's hospital course. Although PF is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or may be life-threatening and necessitate emergency reoperation (grade C). The aim of the present study was to evaluate the incidence of postoperative grade C PF after PD and to assess the prognosis and risk factors for this life-threatening condition. Study design Between January 2000 and December 2006, 680 consecutive patients underwent PD in 5 digestive surgery departments in the northwest region of France (Lille, Amiens, Rouen, and Caen). PF was defined as drain output of any measurable volume of fluid on or after postoperative day 3 with amylase content greater than 3 times the serum amylase activity (ISGPF guidelines). To identify possible risk factors for grade C PF, we reviewed the records of 111 (16.3%) patients with postoperative PF and compared grade C cases with grade A+B cases. Results The median age was 59 years (range 22–87). The male-to-female ratio was 1.6:1. Fifty-six (50.4%) PDs were performed via pancreaticogastrostomy and 55 via pancreaticojejunostomy. Overall mortality was 2% (n = 14). Grade C PF was observed in 36 (32%) patients, of whom 17 (47%) had sepsis due to an abdominal collection, 16 (44%) had postoperative bleeding, 10 (27.7%) had bleeding associated with abdominal collection, and 3 (9%) had multi-organ failure due to other causes. Of these 36 patients, 35 (97%) underwent reoperation. The mortality rate in grade C PF patients was 38.8%. The major causes of death were sepsis (n = 6) and recurrent bleeding after reoperation (n = 5). Grade C PF increased the duration of postoperative hospitalization (46 vs 29 days, P P values of .011, .003, and .001, respectively. No risk factors for grade C PF were identified in a multivariate analysis. The sensibility, specificity, positive predictive value, and negative predictive value of the presence of the 3 risk factors for grade C PF were 13.89%, 100%, 100%, and 70.75%, respectively. Conclusion Sixteen percent of patients had PF after PD. Among them, 30% had grade C PF, with a mortality rate of about 40%. Achievement of a 100% predictive positive value for grade C PF after PD in individuals with 3 discriminant risk factors (peroperative soft pancreatic parenchyma, peroperative transfusion, and postoperative bleeding) is a first step towards the identification of high-risk patients who should be managed differently from other patients with PF during or after PD.
  • References (31)
  • Citations (160)
Cite
References31
Newest
Published on Dec 1, 2007in Annals of Surgery 9.48
Abhishek Mathur10
Estimated H-index: 10
(IU: Indiana University),
Henry A. Pitt55
Estimated H-index: 55
(IU: Indiana University)
+ 6 AuthorsKeith D. Lillemoe96
Estimated H-index: 96
(IU: Indiana University)
Objective: To determine whether patients who develop a pancreatic fistula after pancreatoduodenectomy are more likely to have pancreatic fat than matched controls. Background: Pancreatic fistula continues to be a major cause of postoperative morbidity and increased length of stay after pancreatoduodenectomy. Factors associated with postoperative pancreatic fistula include a soft pancreas, a small pancreatic duct, the underlying pancreatic pathology, the regional blood supply, and surgeon's exper...
Published on Sep 1, 2007in Annals of Surgery 9.48
RonnieTung-PingPoon87
Estimated H-index: 87
,
Sheung-TatFan108
Estimated H-index: 108
+ 4 AuthorsJohn Wong109
Estimated H-index: 109
Pancreaticoduodenectomy is the treatment of choice for patients with resectable carcinoma of the pancreatic head and periampullary region. In recent years, mortality rate of pancreaticoduodenectomy has declined to <5% in many institutions around the world.1–4 However, pancreatic fistula still occurs in 5% to 40% of patients after pancreaticoduodenectomy, depending on the definition of leakage.5–8 The reduction in operative mortality over the past few decades has not been accompanied by a notable...
Published on Jul 1, 2007in Surgery 3.48
Moritz N. Wente36
Estimated H-index: 36
(Heidelberg University),
Johannes Veit5
Estimated H-index: 5
(Heidelberg University)
+ 9 AuthorsMichael G. Sarr85
Estimated H-index: 85
(Mayo Clinic)
Background Postoperative hemorrhage is one of the most severe complications after pancreatic surgery. Due to the lack of an internationally accepted, universal definition of postpancreatectomy hemorrhage (PPH), the incidences reported in the literature vary considerably, even in reports from randomized controlled trials. Because of these variations in the definition of what constitutes a PPH, the incidences of its occurrence are not comparable. Methods The International Study Group of Pancreatic...
Published on Jul 1, 2007in American Journal of Surgery 2.20
Thomas Blanc1
Estimated H-index: 1
,
Alexandre Cortes7
Estimated H-index: 7
+ 4 AuthorsAlain Sauvanet73
Estimated H-index: 73
Abstract Background This study analyzed presentation and management of hemorrhage after pancreaticoduodenectomy (PD) to determine the respective role of surgery and embolization. Methods From January 1992 to March 2005, 411 patients underwent PD and were analyzed with regard to postoperative hemorrhage. Results Hemorrhage occurred in 27 patients (7%), either within the first 3 postoperative days (“early” hemorrhage, n = 11) or after day 8 (“delayed” hemorrhage, n = 16, including 4 with “sentinel...
Published on Mar 1, 2007in Annals of Surgery 9.48
Wande B. Pratt17
Estimated H-index: 17
,
Shishir K. Maithel36
Estimated H-index: 36
+ 3 AuthorsCharles M. Vollmer38
Estimated H-index: 38
Pancreatic fistula is widely regarded as the most ominous of complications following pancreatic resection. Its clinical impact and sequelae have been previously described and shown to contribute to the development of other morbid complications and high rates of mortality.1–4 Despite refinements in operative technique and advancements in postoperative management, fistulas still occur with a frequency of 5% to 30%.5–12 Efforts to mitigate this problem have included technical considerations (modifi...
Published on Nov 1, 2006in Journal of Gastrointestinal Surgery 2.69
Jordan M. Winter34
Estimated H-index: 34
(Johns Hopkins University),
John L. Cameron6
Estimated H-index: 6
(Johns Hopkins University)
+ 11 AuthorsTaylor S. Riall33
Estimated H-index: 33
(Johns Hopkins University)
Pancreaticoduodenectomy (PD) with the possible addition of neoadjuvant or adjuvant therapy is the standard of care in the United States for adenocarcinoma originating in the pancreatic head, neck, and uncinate process. We reviewed 1423 patients who underwent a PD for a malignancy originating in the pancreas at our institution between 1970 and 2006. We examined 1175 PDs for ductal adenocarcinomas in greater detail. Eighteen different histological types of pancreatic cancer were identified; the mo...
Published on May 1, 2006in Surgery 3.48
Fabrice Muscari24
Estimated H-index: 24
,
Bertrand Suc21
Estimated H-index: 21
+ 7 AuthorsAlexandre Radovanovic1
Estimated H-index: 1
Background Studies of risk factors after pancreatoduodenectomy are few: some concern restricted populations and others are based on administrative data. Methods Multicenter clinical data were collected for 300 patients undergoing pancreatoduodenectomy to determine (by univariate and multivariate analysis) preoperative and intraoperative risk factors for mortality and intra-abdominal complications (IACs), including pancreatic fistula. Fourteen factors including the center and volume effect were a...
Published on Jan 1, 2006in Annals of Surgery 9.48
Steve M. M. de Castro12
Estimated H-index: 12
,
Koert F. D. Kuhlmann12
Estimated H-index: 12
+ 5 AuthorsDirk J. Gouma85
Estimated H-index: 85
Objective: To analyze the management of delayed massive hemorrhage (DMH) after major pancreatic and biliary surgery. Summary Background Data: Despite a decreased mortality rate for pancreatic and biliary surgery, DMH is still an important cause of postoperative mortality. The aim of the present study was to analyze the management of DMH after pancreatic and biliary surgery, and specifically to assess the role of embolization and surgical intervention. Methods: The study group (SG) consisted of 1...
Published on Dec 1, 2005in Annals of Surgery 9.48
Silvio Balzan4
Estimated H-index: 4
,
Jacques Belghiti101
Estimated H-index: 101
+ 4 AuthorsFrançois Durand53
Estimated H-index: 53
Objective: To standardize the definition of postoperative liver failure (PLF) for prediction of early mortality after hepatectomy.
Cited By160
Newest
Published in JAMA Surgery 10.67
Thomas P. Hank (Harvard University), Marta Sandini2
Estimated H-index: 2
(Harvard University)
+ -3 AuthorsCarlos Fernandez-del Castillo81
Estimated H-index: 81
(Harvard University)
Importance In the past decade, the use of neoadjuvant therapy (NAT) has increased for patients with borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Data on pancreatic fistula and related overall survival (OS) in this setting are limited. Objective To compare postoperative complications in patients undergoing either upfront resection or pancreatectomy following NAT, focusing on clinically relevant postoperative pancreatic fistula (CR-POPF) and potential associations with ...
Published in Updates in Surgery
Fabio Uggeri7
Estimated H-index: 7
(University of Milano-Bicocca),
Luca Nespoli12
Estimated H-index: 12
(University of Milano-Bicocca)
+ -3 AuthorsLuca Gianotti43
Estimated H-index: 43
(University of Milano-Bicocca)
Precise risk factors for bleeding after pancreatoduodenectomy (PD) need to be further explored. We aimed to identify which variables were associated with the risk of post-pancreatectomy hemorrhage (PPH) and benchmark the PPH rate and related outcome in our intermediate-volume center with the current literature. We retrospectively analyzed 183 PD records. We investigated the association between PPH and a number of pre-surgical (age, body mass index, bilirubin plasma level, gender, American Societ...
Published in Hpb 3.05
F. Jasmijn Smits3
Estimated H-index: 3
(UU: Utrecht University),
Quintus Molenaar25
Estimated H-index: 25
(UU: Utrecht University)
+ -3 AuthorsHjalmar C. van Santvoort37
Estimated H-index: 37
(UU: Utrecht University)
Abstract Background Early recognition of postoperative pancreatic fistula might decrease the risk of subsequent life threatening complications. The aim of this review was to systematically evaluate the accuracy of postoperative clinical, biochemical and radiologic variables for early recognition of clinically relevant postoperative pancreatic fistula. Methods A systematic literature search was performed up to August 2018. Clinical studies reporting on the association between postoperative variab...
Published in Hpb 3.05
Tommaso Giuliani (University of Verona), Stefano Andrianello6
Estimated H-index: 6
(University of Verona)
+ -3 AuthorsRoberto Salvia46
Estimated H-index: 46
(University of Verona)
Abstract Background Scores predicting postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) mainly use intraoperative predictors. The aim of this study is to investigate the role of pancreatic exocrine function expressed by fecal elastase (FE-1) as preoperative predictor of POPF. Methods Patients scheduled for PD at the Department of General and Pancreatic Surgery, University of Verona Hospital, from April 2017 to July 2018 were prospectively enrolled. FE-1 was measured in a...
Published on Apr 16, 2019in European Surgery-acta Chirurgica Austriaca 0.48
Daniel Putzer17
Estimated H-index: 17
,
Peter Schullian11
Estimated H-index: 11
+ 12 AuthorsManuel Maglione11
Estimated H-index: 11
Background Despite technical advances in surgical resection and postoperative management of the pancreas, surgical procedures of the pancreas are associated with a high rate of complications, resulting in a relevant morbidity and mortality. Early diagnosis and management of complications associated with pancreas surgery is mandatory, favoring a multidisciplinary approach.
Published on Jun 1, 2019in Clinical Radiology 2.08
Yoshifumi Noda10
Estimated H-index: 10
(Gidai: Gifu University),
Satoshi Goshima24
Estimated H-index: 24
(Gidai: Gifu University)
+ 6 AuthorsMasayuki Matsuo17
Estimated H-index: 17
(Gidai: Gifu University)
AIM To evaluate the potential value of magnetic resonance imaging (MRI) for predicting postoperative pancreatic fistula (POPF) in patients with pancreatic cancer (PC) and non-pancreatic cancer (non-PC). MATERIAL AND METHODS This retrospective study was approved by the institutional review board and written informed consent was waived. Forty patients underwent pancreatoduodenectomy due to PC ( n =31) and non-PC ( n =9). The pancreas-to-muscle signal intensity ratio (SIR) on three-dimensional (3D)...
Published on Apr 2, 2019in European Surgery-acta Chirurgica Austriaca 0.48
Helwig Wundsam3
Estimated H-index: 3
,
Christiane Sophie Rösch + 1 AuthorsR. Függer29
Estimated H-index: 29
Background Despite the significant improvement concerning perioperative mortality, pancreatoduodenectomy is still a challenging procedure. Pancreatic fistula is the most common complication underlying 30-day mortality. More than 61 surgical techniques of pancreatic anastomosis with a vast number of variations have been published. Moreover, various risk factors favoring the development of postoperative pancreatic fistulas have been identified.
Published on May 1, 2019in Anz Journal of Surgery 1.60
Sung Ryol Lee3
Estimated H-index: 3
(SKKU: Sungkyunkwan University),
Hyung Ook Kim12
Estimated H-index: 12
(SKKU: Sungkyunkwan University),
Jun Ho Shin11
Estimated H-index: 11
(SKKU: Sungkyunkwan University)
Vishal Gupta10
Estimated H-index: 10
(King George's Medical University),
Saket Kumar1
Estimated H-index: 1
(King George's Medical University)
+ 5 AuthorsAbhijit Chandra10
Estimated H-index: 10
(King George's Medical University)
Abstract Background Blumgart's pancreaticojejunostomy (PJ) has been described with low pancreatic leak rates. This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative outcomes. Methods We performed a single-center retrospective analysis of a cohort of 81 patients who underwent pancreaticoduodenectomy in our department from January 2011 to February 2018. The primary endpoint was the occurrence of a clinically relevant postoperative panc...
Published on Apr 1, 2019in Journal of Visceral Surgery 2.22
J. Dembinski , C. Mariette35
Estimated H-index: 35
+ 8 AuthorsStéphanie Truant19
Estimated H-index: 19
Summary Background To determine whether the timing of removal of abdominal drainage (AD) after pancreatoduodenectomy (PD) influences the 30-day surgical site infection (30-day SSI) rate. Methods A multicenter randomized, intention-to-treat trial with two parallel arms (superiority of early vs. standard AD removal on SSI) was performed between 2011 and 2015 in patients with no pancreatic fistula (PF) on POD3 after PD ( NCT01368094 ). The primary endpoint was the 30-day SSI rate. The secondary end...