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Predictive factors for pancreatic fistula following pancreatectomy

Published on Oct 1, 2014in Langenbeck's Archives of Surgery2.093
· DOI :10.1007/s00423-014-1220-8
Matthew T. McMillan19
Estimated H-index: 19
(UPenn: University of Pennsylvania),
Charles M. Vollmer30
Estimated H-index: 30
(UPenn: University of Pennsylvania)
Abstract
Background Postoperative pancreatic fistula is a significant contributor to morbidity following proximal and distal pancreatic resections. In recent decades, the incidence of fistula has ranged from 2 to 33 %; however, the consistent identification of risk factors has been difficult due to significant variability in the definition of pancreatic fistula.
  • References (131)
  • Citations (33)
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References131
Newest
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 19
#2William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
view all 13 authors...
Background A recent randomized, controlled trial investigating intraperitoneal drain use during pancreatoduodenectomy (PD) had a primary goal of assessing overall morbidity. It was terminated early with findings that routine elimination of drains in PD increases mortality and the severity and frequency of overall complications. Here, we provide a follow-up analysis of drain value in reference to clinically relevant postoperative pancreatic fistula (CR-POPF).
44 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 19
#2John D. Christein (UAB: University of Alabama at Birmingham)H-Index: 31
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
view all 9 authors...
Background Most accrued evidence regarding prophylactic octreotide for a pancreatoduodenectomy (PD) predates the advent of the International Study Group of Pancreatic Fistula (ISGPF) classification system for a post-operative pancreatic fistula (POPF), and its efficacy in the setting of high POPF risk is unknown. The Fistula Risk Score (FRS) predicts the risk and impact of a clinically relevant (CR)-POPF and can be useful in assessing the impact of octreotide in scenarios of risk.
37 CitationsSource
#1Peter J. Allen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 71
#2Mithat GonenH-Index: 107
Last. William R. JarnaginH-Index: 13
view all 12 authors...
Background Postoperative pancreatic fistula is a major contributor to complications and death associated with pancreatic resection. Pasireotide, a somatostatin analogue that has a longer half-life than octreotide and a broader binding profile, decreases pancreatic exocrine secretions and may prevent postoperative pancreatic fistula. Methods We conducted a single-center, randomized, double-blind trial of perioperative subcutaneous pasireotide in patients undergoing either pancreaticoduodenectomy ...
174 CitationsSource
#1George Van Buren (BCM: Baylor College of Medicine)H-Index: 18
#2Mark Bloomston (OSU: Ohio State University)H-Index: 40
Last. William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
view all 30 authors...
Abstract To test by randomized prospective multicenter trial the hypothesis that pancreaticoduodenectomy (PD) without the use of intraperitoneal drainage does not increase the frequency or severity of complications. Some surgeons have abandoned the use of drains placed during pancreas resection. We randomized 137 patients to PD with (n = 68, drain group) and without (n = 69, no-drain group) the use of intraperitoneal drainage and compared the safety of this approach and spectrum of complications...
180 CitationsSource
#1Benjamin C. Miller (UPenn: University of Pennsylvania)H-Index: 5
#2John D. Christein (UAB: University of Alabama at Birmingham)H-Index: 31
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
view all 7 authors...
Background The Fistula Risk Score (FRS), a ten-point scale that relies on weighted influence of four variables, has been shown to effectively predict clinically relevant postoperative pancreatic fistula (CR-POPF) development and its consequences after pancreatoduodenectomy (PD). The proposed FRS demonstrated excellent predictive capacity; however, external validation of this tool would confirm its universal applicability.
79 CitationsSource
#1Pietro Addeo (UDS: University of Strasbourg)H-Index: 22
#2Jean Robert DelperoH-Index: 26
Last. Philippe Bachellier (UDS: University of Strasbourg)H-Index: 44
view all 12 authors...
Backgrounds A 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.
75 CitationsSource
#2Murray F. BrennanH-Index: 140
Last. Peter J. AllenH-Index: 71
view all 8 authors...
Abstract The only prospective randomized trial evaluating the use of intraperitoneal drainage following pancreatic resection was published from our institution approximately 10 years ago. The current study sought to evaluate the evolution of practice over the last 5 years. Between June 2006 and June 2011, there were 1122 resections performed. Six surgeons were evenly grouped and compared by practice pattern: routine drainers (drains placed > 95%), selective drainers, and routine nondrainers (dra...
96 CitationsSource
#1Baki Topal (Katholieke Universiteit Leuven)H-Index: 30
#2Steffen Fieuws (Katholieke Universiteit Leuven)H-Index: 46
Last. Jean ClossetH-Index: 24
view all 10 authors...
Summary Background Postoperative pancreatic fistula is the leading cause of death and morbidity after pancreaticoduodenectomy. However, the best reconstruction method to reduce occurrence of fistula is debated. We did a multicentre, randomised superiority trial to compare the outcomes of different reconstructive techniques in patients undergoing pancreaticoduodenectomy for pancreatic or periampullary tumours. Methods Patients aged 18–85 years with confirmed or suspected neoplasms of the pancreas...
153 CitationsSource
#1Teviah Sachs (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 13
#2Wande B. Pratt (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 18
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
view all 5 authors...
Background The efficacy of pancreaticojejunal (P-J) anastomotic stents in preventing clinically relevant postoperative pancreatic fistulas (CR-POPF) after pancreatic resection is poorly understood. We sought to compare the outcomes of stented and nonstented patients in light of recognized risk-factors for the development of CR-POPF and to determine whether outcomes differed once there was a change in practice where use of stents was abandoned. Methods A total of 444 patients underwent proximal p...
29 CitationsSource
#1Kurinchi Selvan Gurusamy (UCL: University College London)H-Index: 47
#2Rahul S. Koti (UCL: University College London)H-Index: 16
Last. Brian R. Davidson (UCL: University College London)H-Index: 50
view all 4 authors...
BackgroundPancreatic resections are associated with high morbidity (30% to 60%) and mortality (5%). Synthetic analogues of somatostatin are advocated by some surgeons to reduce complications following pancreatic surgery, however their use is controversial.ObjectivesTo determine whether prophylactic somatostatin analogues should be used routinely in pancreatic surgery.Search strategyWe searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register, the Cochrane Central...
134 CitationsSource
Cited By33
Newest
#1Elizaveta Vasilyeva (UBC: University of British Columbia)H-Index: 1
#2Jennifer Li (UBC: University of British Columbia)H-Index: 4
Last. Peter T. W. Kim (UBC: University of British Columbia)H-Index: 14
view all 7 authors...
Abstract Background Timely surgical resection in patients with suspected or diagnosed pancreas adenocarcinoma is an essential part of care. We hypothesized that longer surgical wait time was associated with worse oncologic outcomes. Methods A retrospective cohort of patients (N = 144) with resectable pancreas adenocarcinoma was divided into four wait time groups ( 12 weeks), defined from the time of diagnosis on cross-sectional imaging. Overall and recurrence-free survival were analyzed using th...
1 CitationsSource
#1Si Shi (Fudan University)H-Index: 17
#1Maxwell T. Trudeau (UPenn: University of Pennsylvania)H-Index: 1
Last. Xianjun Yu (Fudan University)H-Index: 31
view all 3 authors...
Source
#1Alessandra Pulvirenti (University of Verona)H-Index: 7
#2Luca Landoni (University of Verona)H-Index: 12
Last. Claudio Bassi (University of Verona)H-Index: 81
view all 14 authors...
Abstract Background Postoperative pancreatic fistula is the primary contributor to morbidity after distal pancreatectomy. To date, no techniques used for the transection and closure of the pancreatic stump have shown clear superiority over the others. This study aimed to compare the rate of postoperative pancreatic fistula after pancreatic transection conducted with a reinforced stapler versus an ultrasonic dissector after a distal pancreatectomy. Method Prospectively collected data of consecuti...
Source
#1Ozgur Akgul (The Ohio State University Wexner Medical Center)H-Index: 7
#2Katiuscha Merath (The Ohio State University Wexner Medical Center)H-Index: 11
Last. Timothy M. Pawlik (The Ohio State University Wexner Medical Center)H-Index: 85
view all 11 authors...
Background Postoperative pancreatic fistula (POPF) remains a major cause of morbidity following pancreaticoduodenectomy (PD). We sought to develop and validate a risk score system that utilized preoperative computed tomography (CT) measurements, laboratory values, and intraoperative pancreatic texture to estimate risk of developing POPF after PD.
1 CitationsSource
#1Benno Cardini (Innsbruck Medical University)H-Index: 6
#2Florian Primavesi (Innsbruck Medical University)H-Index: 8
Last. Stefan Stättner (Innsbruck Medical University)H-Index: 16
view all 13 authors...
Background Despite clear advances in decreasing postoperative mortality below 4% after pancreatic resections in experienced centres, specific morbidity according to standardized definitions still remains high. While some recent multicentre studies have reported on complications after pancreatic surgery in Austria, detailed outcome data from single high-volume centres over longer time-periods are scarce. This study provides an in-depth picture of patient characteristics, indications, morbidity an...
1 CitationsSource
#1Marta Sandini (Harvard University)H-Index: 4
#2Carlos Fernandez-del Castillo (Harvard University)H-Index: 83
Last. Motaz Qadan (Harvard University)H-Index: 15
view all 8 authors...
Background While intraoperative fluid overload is associated with higher complication rates following surgery, data for pancreaticoduodenectomy are scarce and heterogeneous. We evaluated multiple prior definitions of restrictive and liberal fluid regimens and analyzed whether these affected surgical outcomes at our tertiary referral center.
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#1Lois A. Daamen (UU: Utrecht University)H-Index: 5
#2F. Jasmijn Smits (UU: Utrecht University)H-Index: 5
Last. Quintus Molenaar (UU: Utrecht University)H-Index: 29
view all 7 authors...
Abstract Background Many pancreatic anastomoses have been proposed to reduce the incidence of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, but a complete overview is lacking. This systematic review and meta-analysis aims to provide an online overview of all pancreatic anastomosis techniques and to evaluate the incidence of clinically relevant POPF in randomized controlled trials (RCTs). Methods A literature search was performed to December 2017. Included were studies givi...
6 CitationsSource
#1Priya M. Puri (UPenn: University of Pennsylvania)H-Index: 3
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
Postoperative pancreatic fistula (POPF) is the most common complication after major pancreatic resections and is the greatest contributor to postoperative morbidity and mortality following pancreatoduodenectomy (PD). The relatively recent establishment of a standardized definition of POPF by the International Study Group of Pancreatic Fistula (ISGPF) allowed for the delineation between innocuous biochemical POPF (grade A) and clinically relevant (CR) POPF (grades B and C). This classification sy...
1 CitationsSource
#1Giovanni CaprettiH-Index: 15
#2Gianpaolo BalzanoH-Index: 39
Last. Alessandro ZerbiH-Index: 38
view all 9 authors...
Background: High hospital volume improves outcomes after pancreatic resection. The aim of this study was to assess if practice and outcomes differed between high- and low-volume centers across which chief surgeons shared a similar training and mentoring. Methods: Data on patients undergoing standard pancreatic resections (2010-2013) at 7 Italian hospitals were collected. Chiefs of pancreatic surgery at each hospital had received the same training, with the same mentor. Two centers were high-volu...
3 CitationsSource
#1Hangyan WangH-Index: 3
#2Dianrong XiuH-Index: 9
Last. Ming TaoH-Index: 5
view all 3 authors...
: 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 pa...
2 CitationsSource