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Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy

Published on Apr 1, 2016in Surgery3.476
· DOI :10.1016/j.surg.2015.10.028
Matthew T. McMillan19
Estimated H-index: 19
(UPenn: University of Pennsylvania),
John D. Christein31
Estimated H-index: 31
(UA: University of Alabama)
+ 9 AuthorsCharles M. Vollmer30
Estimated H-index: 30
(UPenn: University of Pennsylvania)
Sources
Abstract
Background Differences in the behavior of postoperative pancreatic fistulas (POPF) have been described after various pancreatic resections. Here, we compare POPFs after pancreatoduodenectomy (PD) and distal pancreatectomy (DP) using the average complication burden (ACB), a quantitative measure of complication burden. Methods From 2001 to 2014, 837 DPs and 1,533 PDs were performed by 14 surgeons at 4 institutions. POPFs were categorized by International Study Group on Pancreatic Fistula standards as biochemical (grade A) or clinically relevant (CR-POPF; grades B and C). ACB values were derived from fistula severity scores based on the Modified Accordion Severity Grading. The ACB of POPFs was compared between PD and DP. Results POPFs were more common after DP compared with PD (34.5 vs 27.2%; P P P P P Conclusion Although POPFs occur less frequently after PD, they are associated with a greater complication burden compared with DP. ACB varies significantly between health care providers, suggesting the need for risk-adjusted comparisons of complication severity. Using ACB to evaluate a distinct morbidity has the potential to aid in assessing the impact of procedure-specific complications.
  • References (24)
  • Citations (32)
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References24
Newest
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 19
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
Last. Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 27
view all 29 authors...
Introduction International Study Group of Pancreatic Fistula (ISGPF) grade C postoperative pancreatic fistulas (POPF) are the greatest contributor to major morbidity and mortality following pancreatoduodenectomy (PD); however, their infrequent occurrence has hindered deeper analysis. This study sought to develop a predictive algorithm, which could facilitate effective management of this challenging complication.
41 CitationsSource
#1Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
#2Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 10
Last. Steven M. Strasberg (UPenn: University of Pennsylvania)H-Index: 32
view all 15 authors...
Objective: The study aim was to quantify the burden of complications of pancreatoduodenectomy (PD). Background: The Postoperative Morbidity Index (PMI) is a quantitative measure of the average burden of complications of a procedure. It is based on highly validated systems—ACS-NSQIP and the Modified Accordion Severity Grading System. Methods: Nine centers contributed ACS-NSQIP complication data for 1589 patients undergoing PD from 2005 to 2011. Each complication was assigned a severity weight ran...
34 CitationsSource
#1Major K. Lee (UPenn: University of Pennsylvania)H-Index: 15
#2Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 10
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
view all 16 authors...
Background Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP).
14 CitationsSource
#1Dominic E. Sanford (WashU: Washington University in St. Louis)H-Index: 16
#2Cheryl A. Woolsey (WashU: Washington University in St. Louis)H-Index: 10
Last. Steven M. Strasberg (WashU: Washington University in St. Louis)H-Index: 72
view all 7 authors...
Background NSQIP and the Accordion Severity Grading System have recently been used to develop quantitative methods for measuring the burden of postoperative complications. However, other audit methods such as chart reviews and prospective institutional databases are commonly used to gather postoperative complications. The purpose of this study was to evaluate discordance between different audit methods in pancreatoduodenectomy—a common major surgical procedure. The chief aim was to determine how...
8 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 19
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
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.
33 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 9 authors...
Abstract Background The Post‐operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post‐operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system. Methods From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF...
21 CitationsSource
#1Steven M. Strasberg (WashU: Washington University in St. Louis)H-Index: 32
#2Bruce L. Hall (WashU: Washington University in St. Louis)H-Index: 14
Background Postoperative complications are key outcomes of surgical procedures, but currently there is no uniform quantitative measure of complication severity. The purpose of this study was to evaluate and establish feasibility of quantitative morbidity scores for several common abdominal surgical procedures. Study Design Using American College of Surgeons' National Surgical Quality Improvement Program data, complications were identified in 5 common abdominal procedures for one institution in 2...
63 CitationsSource
#1Takeshi Sudo (Hiroshima University)H-Index: 25
#2Yoshiaki Murakami (Hiroshima University)H-Index: 34
Last. Taijiro Sueda (Hiroshima University)H-Index: 40
view all 8 authors...
Abstract Background Management of the pancreatic remnant after distal pancreatectomy remains a clinically relevant problem and a significant clinical challenge. We evaluated the safety and efficacy of duct-to-mucosa pancreaticogastrostomy for preventing pancreatic fistula development after distal pancreatectomy. Methods Twenty-one patients underwent distal pancreatectomy using the duct-to-mucosa pancreaticogastrostomy and the clinical data were collected prospectively. Pancreatic fistula was def...
19 CitationsSource
#1Christian Schmidt (IU: Indiana University)H-Index: 42
#2Olivier Turrini (IU: Indiana University)H-Index: 30
Last. Keith D. Lillemoe (IU: Indiana University)H-Index: 97
view all 9 authors...
Objective To determine the importance of hospital volume, surgeon experience, and surgeon volume in performing pancreaticoduodenectomy (PD). Design, Setting, and Patients From 1980 through 2007, 1003 patients underwent PD by 19 surgeons at a university hospital. Main Outcome Measures Patient morbidity and mortality, quality of resection, and learning curve were examined according to hospital volume (period 1: 1980-2003 vs period 2: 2004-2007), surgeon experience (total number of PDs), and surgeo...
214 CitationsSource
#1Matthew R. Porembka (WashU: Washington University in St. Louis)H-Index: 17
#2Bruce L. Hall (WashU: Washington University in St. Louis)H-Index: 38
Last. Steven M. Strasberg (WashU: Washington University in St. Louis)H-Index: 32
view all 4 authors...
Background To quantify severity of postoperative complications based on the Accordion Severity Grading System, determine the ability of severity grading to enhance National Surgical Quality Improvement Program (NSQIP) data, and develop an aggregate measure of severity of complications (the postoperative morbidity index). Study Design Forty-three surgical experts rated case vignettes containing postoperative complications on a severity scale. Vignettes were based on the Accordion Severity Grading...
119 CitationsSource
Cited By32
Newest
#1Victor Rodrigues (Autonomous University of Barcelona)
#2Cristina Dopazo (Autonomous University of Barcelona)H-Index: 13
Last. Ramón Charco (Autonomous University of Barcelona)H-Index: 23
view all 10 authors...
Resumen Introduccion El objetivo del presente estudio es analizar el impacto de la afectacion del ganglio de la arteria hepatica (GAH) en la supervivencia de los pacientes intervenidos de duodenopancreatectomia cefalica (DPC) por adenocarcinoma (ADK) de cabeza de pancreas. Metodos Estudio retrospectivo unicentrico de pacientes intervenidos de DPC por ADK de cabeza de pancreas, con estudio anatomopatologico independiente del GAH. Los pacientes se agruparon en: 1) pacientes sin afectacion del GAH ...
Source
#1Victor Rodrigues (Autonomous University of Barcelona)
#2Cristina Dopazo (Autonomous University of Barcelona)H-Index: 13
Last. Ramón Charco (Autonomous University of Barcelona)H-Index: 23
view all 10 authors...
INTRODUCTION: The aim of this study is to analyze the impact of hepatic artery lymph node (HALN) involvement on the survival of patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA). METHODS: A single-center retrospective study analyzing patients who underwent PD for PA. Patients were included if, during PD, the HALN was submitted for pathologic evaluation. Patients were stratified by node status: PPLN- (peripancreatic lymph node)/HALN-, PPLN+/HALN- and PPLN+/HALN+....
Source
#1Sophia Chikhladze (University of Freiburg)H-Index: 5
#2Ann-Kathrin Lederer (University of Freiburg)H-Index: 2
Last. Uwe A. Wittel (University of Freiburg)H-Index: 14
view all 7 authors...
Pancreatic metastasis is a rare cause for pancreas surgery and often a sign of advanced disease no chance of curative-intent treatment. However, surgery for metastasis might be a promising approach to improve patients’ survival. The aim of this study was to analyze the surgical and oncological outcome after pancreatic resection of pancreatic metastasis. This is a retrospective cohort analysis of a prospectively-managed database of patients undergoing pancreatic resection at the University of Fre...
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#1Fabio Casciani (UPenn: University of Pennsylvania)
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 30
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#1Timothy E. Newhook (University of Texas MD Anderson Cancer Center)H-Index: 5
#2Eduardo A. Vega (University of Texas MD Anderson Cancer Center)H-Index: 6
Last. Ching Wei D. Tzeng (University of Texas MD Anderson Cancer Center)H-Index: 25
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Abstract Background First postoperative day drain fluid amylase (DFA1) Methods Patients with DFA1/DFA3 values after pancreaticoduodenectomy or distal pancreatectomy were identified. Patients were risk stratified as “low-risk pancreaticoduodenectomy,” “high-risk pancreaticoduodenectomy,” or “distal pancreatectomy.” Receiver operator characteristic analyses yielded clinically relevant sensitivity thresholds for International Study Group on Pancreatic Surgery grade B/C postoperative pancreatic fist...
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#1Yuan-Yuan Yang (Fujian Medical University)H-Index: 1
#2Chaoqian Zhao (CAS: Chinese Academy of Sciences)H-Index: 6
Last. He-Guang Huang (Fujian Medical University)H-Index: 1
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Abstract The purpose of our research was to verify the feasibility and effectiveness of a novel three-dimensional printed biopolymer device (3DP-BPD) for duct-to-mucosa pancreaticojejunostomy (PJ) in minipigs. Polylactic acid (PLA) was selected as the raw materials for 3DP-BPD. Three components of a 3DP-BPD were designed and manufactured: hollow stent, supporting disk, and nut. A pancreatic duct dilation model was developed in six minipigs. After 4 weeks, minipigs underwent operations with duct-...
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#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
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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...
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#1Thomas Hank (Harvard University)H-Index: 8
#2Marta Sandini (Harvard University)H-Index: 4
Last. Carlos Fernandez-del Castillo (Harvard University)H-Index: 83
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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 ...
8 CitationsSource
#1Roheena Z. Panni (WashU: Washington University in St. Louis)H-Index: 10
#2Jarot Guerra (WashU: Washington University in St. Louis)H-Index: 2
Last. Dominic E. Sanford (WashU: Washington University in St. Louis)H-Index: 16
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Background There is a substantial learning curve associated with minimally invasive pancreaticoduodenectomy (MIPD). We sought to determine if national MIPD pancreatic fistula rates are decreasing with time. Study Design All patients undergoing elective MIPD and accrued into the pancreatectomy-targeted NSQIP database between 2014 and 2017 were included in the study. Trends in MIPD outcomes by year were examined using Cochran-Armitage and Mann-Kendall tests for trend. Multivariable logistic regres...
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#1Mahir Gachabayov (NYMC: New York Medical College)H-Index: 8
#2Shekhar Gogna (NYMC: New York Medical College)H-Index: 1
Last. Xiang D. Dong (NYMC: New York Medical College)
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Abstract Introduction There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. Methods The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fi...
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