Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Surgery
Published in: BMC Surgery 1/2015

Open Access 01-12-2015 | Research article

Risk factors and outcomes of postoperative pancreatic fistula after pancreatico-duodenectomy: an audit of 532 consecutive cases

Authors: Shun-Jun Fu, Shun-Li Shen, Shao-Qiang Li, Wen-Jie Hu, Yun-Peng Hua, Ming Kuang, Li-Jian Liang, Bao-Gang Peng

Published in: BMC Surgery | Issue 1/2015

Login to get access

Abstract

Background

Pancreatic fistula (PF) remains the most challenging complication after pancreaticoduodenectomy (PD). The purpose of this study was to identify the risk factors of PF and delineate its impact on patient outcomes.

Methods

We retrospectively reviewed clinical data of 532 patients who underwent PD and divided them into PF group and no PF group. Risk factors and outcomes of PF following PD were examined.

Results

PF was found in 65 (12.2%) cases, of whom 11 were classified into ISGPF grade A, 42 grade B, and 12 grade C. Clinically serious postoperative complications in the PF versus no PF group were mortality, abdominal bleeding, bile leak, intra-abdominal abscess and pneumonia. Univariate and multivariate analysis showed that blood loss ≥ 500 ml, pancreatic duct diameter ≤ 3 mm and pancreaticojejunostomy type were independent risk factors of PF after PD.

Conclusions

Blood loss ≥ 500 ml, pancreatic duct diameter ≤ 3 mm and pancreatico-jejunostomy type were independent risk factors of PF after PD. PF was related with higher mortality rate, longer hospital stay, and other complications.
Literature
1.
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastro-intest Surg. 2006;10:1199–210.CrossRef
2.
Bottger TC, Junginger T. Factors influencing morbidity and mortality after pancreatico-duodenectomy: critical analysis of 221 resections. World J Surg. 1999;23:164–71.CrossRefPubMed
3.
Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, et al. Pancreatico-duodenectomy; a 20-year experience in 516 patients. Arch Surg. 2004;139:718–25. discussion 725–727.CrossRefPubMed
4.
Braga M, Capretti G, Prcorelli N, Balzano G, Doglioni C, Ariotti R, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg. 2011;254:702–7.CrossRefPubMed
5.
DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreatico-duodenectomy. Ann Surg. 2006;244:931–7.CrossRefPubMedPubMedCentral
6.
Schmidt CM, Choi J, Powell ES, Yiannoutsos CT, Zyromski NJ, Nakeeb A, et al. Pancreatic fistula following pancreatico-duodenectomy: clinical predictors and patient outcomes. HPB Surg. 2009; doi: 10.1155 /2009/404520.
7.
Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer Jr CM. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216:1–14.CrossRefPubMed
8.
Aranha GV, Aaron JM, Shoup M, Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2006;140:561–8.CrossRefPubMed
9.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. International Study Group on Pancreatic Fistula Definition: Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.CrossRefPubMed
10.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DEG) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.CrossRefPubMed
11.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.CrossRefPubMed
12.
Li SQ, Liang LJ, Peng BG, Lu MD, Lai JM, Li DM. Bile leakage after hepatectomy for hepatolithiasis: risk factors and management. Surgery. 2007;141:340–5.CrossRefPubMed
13.
Balcom IV JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten year experience with 733 pancreatic resection: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136:391–8.CrossRefPubMed
14.
Lin JW, Cameron JL, Yeo SJ, Riall TS, Lillemoe KD. Risk factors and outcomes in postpancreatico-duodenectomy pancreaticocutaneous fistula. J Gastrointst Surg. 2004;8:951–9.CrossRef
15.
Kazanjian KK, Hines OJ, Eibl G, Reber HA. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients. Arch Surg. 2005;140:849–55.CrossRefPubMed
16.
Kirihara Y, TakahaShi N, Hashimoto Y, Sclabas GM, Khan S, Moriya T, et al. Prediction of pancreatic anastomotic failure after pancreatoduodenectomy: the use of preoperative, quantitative computed tomography to measure remnant pancreatic volume and body composition. Ann Surg. 2013;257:512–9.CrossRefPubMed
17.
Relles DM, Richards NG, Bloom JP, Kennedy EP, Sauter PK, Leiby BE, et al. Serum blood urea nitrogen and serum albumin on the first postoperative day predict pancreatic fistula and major complications after pancreatico-duodenectomy. J Gastrointest Surg. 2013;17:326–31.CrossRefPubMed
18.
Arnaud JP, Tuech JJ, Cervi C, Bergamaschi R. Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg. 1999;165:357–62.CrossRefPubMed
19.
Ihse I, Axelson J, Hansson L. Pancreaticogastrostomy after subtotal pancreatectomy for cancer. Dig Surg. 1999;16:389–92.CrossRefPubMed
20.
Takano S, Ito Y, Watanabe Y, Yokoyama T, Kubota N, Iwai S. Pancreaticojejunostomy versus pancreatico-gastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg. 2000;87:423–7.CrossRefPubMed
21.
Peng SY, Wang JW, Hong De F, Liu YB, Wang YF. Binding pancreaticoenteric anastomosis: from binding pancreaticojejunostomy to binding pancreaticogastrostomy. Upstate Surg. 2011;63:69–74.
22.
Shen YF, Jin WY. Reconstruction by Pancreaticogastrostomy versus Pancreatico-jejunostomy following Pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Gastroenterol Res and Pract. 2011. doi:10.1155/2012 /627095.
23.
Topal B, Fieuws S, Aerts R, Weerts J, Feryn T, Roeyen G, et al. Belgian Section of Hepatobiliary and PancreaticSurgery: Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreatico-duodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14:655–62.CrossRefPubMed
24.
Sohn TA, Yeo CJ, Cameron JL, Pitt HA, Lillemoe KD. Do preoperative biliary stents increase postpancreaticoduodenectomy complications? J Gastrointest Surg. 2000;4:258–68.CrossRefPubMed
25.
Yeh TS, Jan YY, Jeng LB, Hwang TL, Wang CS, Chao TC, et al. Pancreaticojejunal anatomotic leak after pancreatico-duodenectomy– multivariate analysis of perioperative risk factors. J Surg Res. 1997;67:119–25.CrossRefPubMed
26.
Kawai M, Tani M, Ina S, Hirono S, Nishioka R, Miyazawa M, et al. CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy. World J Surg. 2008;32:82–7.CrossRefPubMed
27.
Ishizaki Y, Sugo H, Yoshimoto J, Imamura H, Kawasaki S. Pancreaticoduodenectomy with or without early ligation of the inferior pancreatoduodenal artery: comparison of intraoperative blood loss and short outcome. World J Surg. 2010;34:2939–44.CrossRefPubMed
28.
Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, proepective, dudal-institution trial. J Am Coll Surg. 2009;208:738–47. discussion 747–749.CrossRefPubMed
29.
Bartoli FG, Arnone GB, Ravera G, Bachi V. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res. 1991;11:1831–48.PubMed
30.
Hatori T. Pancreaticojejunostomy without stent (with video). J Hepatobiliary Pancreat Sci. 2012;19:125–30.CrossRefPubMed
31.
Imaizumi T, Hatori T, Tobita K, Fukuda A, Takasaki K, Makuuchi H. Pancreatico-jejunostomy using duct-to-mucosa anastomosis without a stenting tube. J Hepatobiliary Pancreat Sci. 2006;13:194–201.CrossRef
Metadata
Title
Risk factors and outcomes of postoperative pancreatic fistula after pancreatico-duodenectomy: an audit of 532 consecutive cases
Authors
Shun-Jun Fu
Shun-Li Shen
Shao-Qiang Li
Wen-Jie Hu
Yun-Peng Hua
Ming Kuang
Li-Jian Liang
Bao-Gang Peng
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2015
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-015-0011-7

Other articles of this Issue 1/2015

BMC Surgery 1/2015 Go to the issue

Case report

En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report

Research article

Impact of ABO blood group on the prognosis of patients undergoing surgery for esophageal cancer

Research article

Effect of different surgical methods on headache associated with cervical spondylotic myelopathy and/or radiculopathy

Study protocol

Surgical assessment: measuring unobserved health

Research article

Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality

Case report

Nonfunctional adrenocortical carcinoma initially presenting as retroperitoneal hemorrhage