Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

Published on Aug 1, 2016in Annals of Surgery9.476
· DOI :10.1097/SLA.0000000000001537
Matthew T. McMillan17
Estimated H-index: 17
(Mayo Clinic),
Sameer Soi6
Estimated H-index: 6
+ 24 AuthorsCharles M. Vollmer40
Estimated H-index: 40
Objective:To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator.Background:Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of
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Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using Internat...
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Even under the most expert care, a properly constructed intestinal anastomosis can fail to heal, resulting in leakage of its contents, peritonitis, and sepsis. The cause of anastomotic leak remains unknown, and its incidence has not changed in decades. We demonstrate that the commensal bacterium Enterococcus faecalis contributes to the pathogenesis of anastomotic leak through its capacity to degrade collagen and to activate tissue matrix metalloproteinase 9 (MMP9) in host intestinal tissues. We ...
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Abstract To review prospective randomized controlled trials to determine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is associated with lower risks of mortality and pancreatic fistula after pancreaticoduodenectomy (PD). Previous studies comparing reconstruction by PG and PJ reported conflicting results regarding the relative risks of mortality and pancreatic fistula after these procedures. MEDLINE, the Cochrane Trials Register, and EMBASE were searched for prospective rand...
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#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
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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).
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#1Amanda B. Cooper (Penn State Milton S. Hershey Medical Center)H-Index: 13
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Introduction The impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
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#1Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 28
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#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
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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.
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#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
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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...
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Background Large centralized databases are used with increasing frequency for reporting hospital-specific and nationwide trends and outcomes after various surgical procedures in order to improve quality of surgical care. American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) is a risk-adjusted, case-weighted complication tracking initiative that reports 30-day outcomes from more than 400 academic and community institutions in the US. However, the accuracy of event...
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#1Dong Wang (Capital Medical University)
#2Xiao Liu (Capital Medical University)
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BACKGROUND: Pancreaticoduodenectomy (PD) remains the major curative operation for malignant neoplasm of pancreas or cancerous tumors near the pancreas. Despite advancements in recent years, the postoperative recurrence rate of these neoplasms and tumors remains high. Moreover, overall morbidity remains high due to clinically relevant postoperative pancreatic fistula (POPF). METHODS: To compare the clinical outcomes of modified invaginated anastomosis and mucosa-to-mucosa anastomosis, this retros...
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#2Domenico Tamburrino (Sapienza University of Rome)H-Index: 13
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Abstract Background Postoperative acute pancreatitis (POAP) can be a possible cause of postoperative pancreatic fistula (POPF). The present study aimed to evaluate the role of clinically-relevant POAP (CR-POAP), defined according to different cut-offs of postoperative amylase (AMS) values and C-reactive protein (CRP), in the development of clinically relevant POPF (CR-POPF) after pancreaticoduodenectomy (PD). Methods Data from 610 patients who underwent PD (2015–2018) were analyzed. Patients wer...
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#2Chiara Ricci (UNIBO: University of Bologna)H-Index: 33
Last. Antonio ColecchiaH-Index: 33
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The clinical usefulness of pancreatic elastography (PE) in the assessment of the pancreatic texture before pancreatic resection still remains uncertain. The aims are: to evaluate the value of pancreatic stiffness in both healthy volunteers and patients affected by pancreatic tumor; to evaluate the ability of PE in predicting clinically relevant postoperative pancreatic fistula (CR-POPF). Pancreatic stiffness of healthy subjects was compared with those of pancreatic tumors measuring shear wave ve...
#1Jian Lin (Fujian Medical University)
#2Biqing Ni (Fujian Medical University)
Last. Guozhong Liu (Fujian Medical University)
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#1Yoshinori Takeda (Juntendo University)
#2Akio Saiura (Juntendo University)H-Index: 1
Last. Hiromichi Ito (JFCR: Japanese Foundation for Cancer Research)H-Index: 3
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Background As complete prevention of postoperative pancreatic fistula (POPF) after pancreatic surgery remains difficult, many risk factors for clinically relevant POPF (CR-POPF) have been reported. However, their clinical impact could be limited because all previous reports included patients without biochemical leakage (BL) that rarely developed to CR-POPF. Therefore, a new strategy for identifying high-risk patients who develop delayed complications from patients with confirmed BL and for imple...
#1Bor-Uei Shyr (Taipei Veterans General Hospital)H-Index: 3
#2Bor-Shiuan Shyr (Taipei Veterans General Hospital)
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Summary Background/Objective There are no reports available on patient satisfaction and quality-of-life after robotic pancreaticoduodenectomy (RPD). This study aimed to evaluate not only surgical outcomes but also patient satisfaction after RPD. Methods Prospectively collected data for RPD were analyzed for surgical outcomes. Questionnaires were sent to patients to assess patient satisfaction regarding RPD. Results The study included 105 patients who underwent RPD, with 44 (41.9%) patients prese...
#1T. Vuorela (UH: University of Helsinki)
#1Vuorela Tiina (UH: University of Helsinki)
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Abstract Objectives Post-operative pancreatic fistula (POPF) is a feared complication after a pancreaticoduodenectomy. Previously in a randomized trial found fewer clinically relevant fistulas (CR-POPF) accompanying administration of perioperative pasireotide. Our hospital previously found that the risk for CR-POPF reached 7% in pancreaticoduodenectomy patients. Here, we aimed to determine the CR-POPF rate accompanying prophylactic pasireotide in patients with a normal pancreas at resection leve...
#1Si Shi (Fudan University)H-Index: 13
#1Maxwell T. Trudeau (UPenn: University of Pennsylvania)
Last. Xianjun Yu (Fudan University)H-Index: 30
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#1Maxwell T. Trudeau (UPenn: University of Pennsylvania)
#2Laura Maggino (UPenn: University of Pennsylvania)H-Index: 6
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
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Abstract Background Intraoperative drain use for pancreatoduodenectomy (PD) has been practiced in an unconditional, binary manner (placement/no-placement). Alternatively, dynamic drain management has been introduced, incorporating the Fistula Risk Score (FRS) and drain fluid amylase (DFA) analysis, to mitigate clinically-relevant pancreatic fistula (CR-POPF). Study Design An extended experience with dynamic drain management was employed at a single institution for 400 consecutive PDs (2014-2019)...