Top

Published in:

01-04-2016

An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions

Authors: Patricio M. Polanco, Mazen S. Zenati, Melissa E. Hogg, Murtaza Shakir, Brian A. Boone, David L. Bartlett, Herbert J. Zeh, Amer H. Zureikat

Published in: Surgical Endoscopy | Issue 4/2016

Abstract

Background

Proponents of the robotic platform site its potential advantages in complex reconstructions such as the pancreaticojejunal anastomosis; however, the incidence and risk factors for postoperative pancreatic fistula (POPF) after robotic pancreaticoduodenectomy (RPD) have not been characterized.

Objective

To identify independent risk factors for POPF after RPD.

Methods

A prospectively maintained database of patients that underwent RPD (2008–2013) with a standardized pancreaticojejunostomy was analyzed. Univariate and multivariate analyses (UVA/MVA) were used to identify independent predictors for POPF. The POPF prognostic scores developed by Braga and Callery for open pancreaticoduodenectomy were then applied with logistic regression analysis on this RPD cohort.

Results

One hundred and fifty consecutive RPDs were analyzed. POPF occurred in 26 (17.3 %); 13 (8.6 %) of which were ISGPF category B and C. On UVA, patients with POPF had larger body mass index (BMI), smaller pancreatic duct diameter, smaller tumor size, longer OR time, larger estimated blood loss (EBL) and RBC transfusion (all p < 0.05). Higher EBL, duct size <4 mm, larger BMI and small tumor size remained the best independent risk factors for POPF on MVA. Increased Callery (OR 1.46, 95 % CI, p = 0.001) and Braga (OR 1.2, 95 % CI, p = 0.005) scores predicted an increased risk of POPF in this RPD cohort.

Conclusions

Larger BMI, higher EBL, smaller tumor size and smaller duct diameter are the main predictors of POPF in RPD.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRefPubMed

Denbo JW, Orr WS, Zarzaur BL et al (2012) Toward defining grade C pancreatic fistula following pancreaticoduodenectomy: incidence, risk factors, management and outcome. HPB (Oxford) 14:589–593CrossRef

Addeo P, Delpero JR, Paye F et al (2014) Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association. HPB (Oxford) 16(1):46–55CrossRef

Grobmyer SR, Kooby D, Blumgart LH, Hochwald SN (2010) Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J Am Coll Surg 210(1):54–59CrossRefPubMed

Reid-Lombardo KM, Farnell MB, Crippa S et al (2007) Pancreatic Anastomotic leak study group. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1507 patients: a report from the pancreatic anastomotic leak study group. J Gastrointest Surg 11(11):1451–1458 (discussion 1459) CrossRefPubMed

Roberts KJ, Storey R, Hodson J, Smith AM, Morris-Stiff G (2013) Pre-operative prediction of pancreatic fistula: is it possible? Pancreatology 13(4):423–428CrossRefPubMed

Wellner UF, Kayser G, Lapshyn H et al (2010) A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB 12(10):696–702CrossRefPubMedPubMedCentral

Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD (2004) Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 8(8):951–959CrossRefPubMed

Sato N, Yamaguchi K, Chijiiwa K, Tanaka M (1998) Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 133(10):1094–1098CrossRefPubMed

10.

Pratt WB, Callery MP, Vollmer CM Jr (2008) Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 32(3):419–428CrossRefPubMed

11.

Braga M, Capretti G, Pecorelli N et al (2011) A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg 254(5):702–707 (discussion 707–708) CrossRefPubMed

12.

Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14CrossRefPubMed

13.

Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145(1):19–23CrossRefPubMed

14.

Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260(4):633–638 (discussion 638–640) CrossRefPubMed

15.

Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the accordion severity grading system. J Am Coll Surg 215(6):810–819CrossRefPubMed

16.

Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg. 258(4):554–559 (discussion 559–562) PubMedPubMedCentral

17.

Nguyen KT, Zureikat AH, Chalikonda S, Bartlett DL, Moser AJ, Zeh HJ (2011) Technical aspects of robotic-assisted pancreaticoduodenectomy (RAPD). J Gastrointest Surg 15(5):870–875CrossRefPubMed

18.

Muscari F, Suc B, Kirzin S et al (2006) Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery 139(5):591–598CrossRefPubMed

19.

Kent TS, Sachs TE, Callery MP, Vollmer CM Jr (2011) Readmission after major pancreatic resection: a necessary evil? J Am Coll Surg 213(4):515–523CrossRefPubMed

20.

Aloia TA, Lee JE, Vauthey JN et al (2007) Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy? JACS 204(3):347–355

21.

Vollmer CM Jr, Sanchez N, Gondek S et al (2012) A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg 16(1):89–102 (discussion 102–103) CrossRefPubMed

22.

Bassi C, Falconi M, Molinari E et al (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242(6):767–771 (discussion 771–763) CrossRefPubMedPubMedCentral

23.

Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222(4):580–588 (discussion 588–592) CrossRefPubMedPubMedCentral

24.

Winter JM, Cameron JL, Campbell KA et al (2006) Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 10(9):1280–1290 (discussion 1290) CrossRefPubMed

25.

Poon RT, Fan ST, Lo CM et al (2007) External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 246(3):425–433 (discussion 433--435) CrossRefPubMedPubMedCentral

26.

Connor S, Alexakis N, Garden OJ, Leandros E, Bramis J, Wigmore SJ (2005) Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg 92(9):1059–1067CrossRefPubMed

27.

Allen PJ, Gonen M, Brennan MF et al (2014) Pasireotide for postoperative pancreatic fistula. NEJM 370(21):2014–2022CrossRefPubMed

28.

Mezhir JJ (2013) Optimizing pancreatectomy outcomes: follow the evidence. J Surg Res 181(2):213–215CrossRefPubMed

29.

Kosaka H, Kuroda N, Suzumura K, Asano Y, Okada T, Fujimoto J (2014) Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy. HPB 21(2):128–133

30.

Choe YM, Lee KY, Oh CA et al (2008) Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol 14(45):6970–6974CrossRefPubMedPubMedCentral

31.

Kim Z, Kim MJ, Kim JH et al (2009) Prediction of post-operative pancreatic fistula in pancreaticoduodenectomy patients using pre-operative MRI: a pilot study. HPB 11(3):215–221CrossRefPubMedPubMedCentral

32.

Frozanpor F, Loizou L, Ansorge C, Segersvard R, Lundell L, Albiin N (2012) Preoperative pancreas CT/MRI characteristics predict fistula rate after pancreaticoduodenectomy. World J Surg 36(8):1858–1865CrossRefPubMed

33.

Wada K, Traverso LW (2006) Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope. Surgery 139(6):735–742CrossRefPubMed

34.

Mathur A, Pitt HA, Marine M et al (2007) Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 246(6):1058–1064CrossRefPubMed

35.

Gaujoux S, Cortes A, Couvelard A et al (2010) Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery 148(1):15–23CrossRefPubMed

36.

Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26(9):2397–2402CrossRefPubMed

37.

Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. Int J Surg 10(9):475–479CrossRefPubMed

38.

Ramsey AM, Martin RC (2011) Body mass index and outcomes from pancreatic resection: a review and meta-analysis. J Gastrointest Surg 15(9):1633–1642CrossRefPubMed

39.

Tsai S, Choti MA, Assumpcao L et al (2010) Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: a large single-institution study. J Gastrointest Surg 14(7):1143–1150CrossRefPubMed

40.

Williams TK, Rosato EL, Kennedy EP et al (2009) Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 208(2):210–217CrossRefPubMed

41.

Dandona M, Linehan D, Hawkins W, Strasberg S, Gao F, Wang-Gillam A (2011) Influence of obesity and other risk factors on survival outcomes in patients undergoing pancreaticoduodenectomy for pancreatic cancer. Pancreas 40(6):931–937CrossRefPubMed

Title: An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions
Authors: Patricio M. Polanco
Mazen S. Zenati
Melissa E. Hogg
Murtaza Shakir
Brian A. Boone
David L. Bartlett
Herbert J. Zeh
Amer H. Zureikat
Publication date: 01-04-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4366-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions

Abstract

Background

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2016

Endoscopic and oncologic outcomes according to indication criteria of endoscopic resection for early gastric cancer: a systematic review and meta-analysis

Room air versus carbon dioxide pneumoperitoneum: effects on oxidative state, apoptosis and histology of splanchnic organs

Laparoscopic narrow band imaging for detection of occult cancer metastases: a randomized feasibility trial

Effectiveness of Surgicel® (Fibrillar) in patients with colorectal endoscopic submucosal dissection

Laparoscopic partial nephrectomy without intracorporeal suturing

Comparison between orogastric tube/bougie and a suction calibration system for effects on operative duration, staple-line corkscrewing, and esophageal perforation during laparoscopic sleeve gastrectomy