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Zhu Y, Wu D, Yang H, Lu Z, Wang Z, Zu G, Li Z, Xu X, Zhang Y, Chen X, Chen W. Analysis of factors influencing pancreatic fistula after minimally invasive pancreaticoduodenectomy and establishment of a new prediction model for clinically relevant pancreatic fistula. Surg Endosc 2024; 38:2622-2631. [PMID: 38499780 PMCID: PMC11078842 DOI: 10.1007/s00464-024-10770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is the most prevalent complications following minimally invasive pancreaticoduodenectomy (MIPD). Only one model related to MIPD exists, and previous POPF scoring prediction methods are based on open pancreaticoduodenectomy patients. Our objectives are to determine the variables that may increase the probability of pancreatic fistula following MIPD and to develop and validate a POPF predictive risk model. METHODS Data from 432 patients who underwent MIPD between July 2015 and May 2022 were retrospectively collected. A nomogram prediction model was created using multivariate logistic regression analysis to evaluate independent factors for POPF in patients undergoing MIPD in the modeling cohort. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) and the calibration curve were used to verify the nomogram prediction model internally and externally within the modeling cohort and the verification cohort. RESULTS Multivariate logistic regression analysis showed that body mass index (BMI), albumin, triglycerides, pancreatic duct diameter, pathological diagnosis and intraoperative bleeding were independent variables for POPF. On the basis of this information, a model for the prediction of risks associated with POPF was developed. In accordance with the ROC analysis, the modeling cohort's AUC was 0.819 (95% CI 0.747-0.891), the internal validation cohort's AUC was 0.830 (95% CI 0.747-0.912), and the external validation cohort's AUC was 0.793 (95% CI 0.671-0.915). Based on the calibration curve, the estimated values of POPF have a high degree of concordance with the actual values that were measured. CONCLUSIONS This model for predicting the probability of pancreatic fistula following MIPD has strong predictive capacity and can provide a trustworthy predictive method for the early screening of high-risk patients with pancreatic fistula after MIPD and timely clinical intervention.
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Affiliation(s)
- Yuwen Zhu
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Di Wu
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hao Yang
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zekun Lu
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhiliang Wang
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guangchen Zu
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zheng Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaowu Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yue Zhang
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Alterio RE, Meier J, Radi I, Bhat A, Tellez JC, Al Abbas A, Wang S, Porembka M, Mansour J, Yopp A, Zeh HJ, Polanco PM. Defining the Price Tag of Complications Following Pancreatic Surgery: A US National Perspective. J Surg Res 2023; 288:87-98. [PMID: 36963298 DOI: 10.1016/j.jss.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 01/20/2023] [Accepted: 02/18/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Pancreatic surgery tends to have a high rate of postoperative complications due to its complex nature, significantly increasing hospital costs. Our aim was to describe the true association between complications and hospital costs in a national cohort of US patients. METHODS The National Inpatient Sample was used to conduct a retrospective analysis of elective pancreatic resections performed between 2004 and 2017, categorizing them based on whether patients experienced major complications (MaC), minor complications (MiC), or no complications (NC). Multivariable quantile regression was used to analyze how costs varied at different percentiles of the cost curve. RESULTS Of 37,893 patients, 45.3%, 28.6%, and 26.1% experienced NC, MiC, and MaC, respectively. Factors associated with MaC were a Charlson Comorbidity Index of ≥4, prolonged length of stay, proximal pancreatectomy, older age, male sex, and surgery performed at hospitals with a small number of beds or at urban nonteaching hospitals (all P < 0.01). Multivariable quantile regression revealed significant variation in MiC and MaC across the cost curve. At the 50th percentile, MiC increased the cost by $3352 compared to NC while MaC almost doubled the cost of the surgery, increasing it by $20,215 (both P < 0.01). The association between complications and cost was even greater at the 95th percentile, increasing the cost by $10,162 and $108,793 for MiC and MaC, respectively (P < 0.01). CONCLUSIONS MiC and MaC were significantly associated with increased hospital costs. Furthermore, the relationship between MaC and costs was especially apparent at higher percentiles of the cost curve.
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Affiliation(s)
- Rodrigo E Alterio
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennie Meier
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imad Radi
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Archana Bhat
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan C Tellez
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amr Al Abbas
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John Mansour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adam Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Zhang B, Yuan Q, Li S, Xu Z, Chen X, Li L, Shang D. Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29757. [PMID: 35776984 PMCID: PMC9239615 DOI: 10.1097/md.0000000000029757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD. METHODS We searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test. RESULTS A total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%-19%). Male (OR = 1.56, 95% CI: 1.42-1.70), body mass index >25 kg/m2 (OR = 1.98, 95% CI: 1.23-3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66-2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61-4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01-4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47-0.61), vascular resection (OR = 0.57, 95% CI: 0.39-0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57-0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40-1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis. CONCLUSIONS The current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.
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Affiliation(s)
- Biao Zhang
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Qihang Yuan
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Shuang Li
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Zhaohui Xu
- Department of Hernia and Colorectal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xu Chen
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Lunxu Li
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Dong Shang
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
- *Correspondence: Dong Shang, Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang District, Dalian 116011, Liaoning, China ()
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4
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Kamarajah SK, Bundred JR, Lin A, Halle-Smith J, Pande R, Sutcliffe R, Harrison EM, Roberts KJ. Systematic review and meta-analysis of factors associated with post-operative pancreatic fistula following pancreatoduodenectomy. ANZ J Surg 2021; 91:810-821. [PMID: 33135873 DOI: 10.1111/ans.16408] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many studies have explored factors relating to post-operative pancreatic fistula (POPF); however, the original definition (All-POPF) was revised to include only 'clinically relevant' (CR) POPF. This study identified variables associated with the two International Study Group on Pancreatic Surgery definitions to identify which variables are more strongly associated with CR-POPF. METHODS A systematic review identified all studies reporting risk factors for POPF (using both International Study Group on Pancreatic Fistula definitions) following pancreatoduodenectomy. The primary outcome was factors associated with CR-POPF. Meta-analyses (random effects models) of pre-, intra- and post-operative factors associated with POPF in more than two studies were included. RESULTS Among 52 774 patients All-POPF (n = 69 studies) and CR-POPF (n = 53 studies) affected 27% (95% confidence interval (CI95% ) 23-30) and 19% (CI95% 17-22), respectively. Of the 176 factors, 24 and 17 were associated with All- and CR-POPF, respectively. Absence of pre-operative pancreatitis, presence of renal disease, no pre-operative neoadjuvant therapy, use of post-operative somatostatin analogues, absence of associated venous or arterial resection were associated with CR-POPF but not All-POPF. CONCLUSION In conclusion this study demonstrates wide variation in reported rates of POPF and that several risk factors associated with CR-POPF are not used within risk prediction models. Data from this study can be used to shape future studies, research and audit across ethnic and geographic boundaries in POPF following pancreatoduodenectomy.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle-Upon-Tyne, UK
- Institute of Cellular Medicine, University of Newcastle, Newcastle-Upon-Tyne, UK
| | - James R Bundred
- Department of Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aaron Lin
- Department of Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James Halle-Smith
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Rupaly Pande
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Robert Sutcliffe
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Keith J Roberts
- Department of Hepatobiliary and Pancreatic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Clinical Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
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Wang J, Ma R, Churilov L, Eleftheriou P, Nikfarjam M, Christophi C, Weinberg L. The cost of perioperative complications following pancreaticoduodenectomy: A systematic review. Pancreatology 2018; 18:208-220. [PMID: 29331217 DOI: 10.1016/j.pan.2017.12.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/01/2017] [Accepted: 12/18/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Pancreaticoduodenectomy (PD), also known as a Whipple procedure, is commonly performed for a variety of benign and malignant tumours, including of the pancreatic head and surrounding structures. PD is associated with low mortality but high morbidity and costs. Our objective was to describe the financial burden of complications following pancreaticoduodenectomy. METHODS We searched for articles using the MEDLINE, EMBASE, Cochrane and EconLit databases from the year 2000. Additional studies were identified by searching bibliographies. We included studies reporting on hospital cost or charge of in-hospital complications during the index PD admission. Studies including other surgeries but specifically reporting inpatient complication costs of PD were also included. Any type of PD was included. Data was collected using a data extraction table and a narrative synthesis was performed. RESULTS We identified 15 eligible articles. All included articles were retrospective studies. Acceptable evidence for increased cost due to the presence and grade of complication was found. Strong evidence demonstrated the high rate of complications. Weak evidence linked complications with specific constituents of hospital cost. Complication grade was robustly linked with increased length of stay. Not enough evidence was found to demonstrate a link between PD complications and mortality or readmissions. LIMITATIONS Included studies were heterogeneous in setting, methodology, costing data, and grading systems. CONCLUSIONS The presence and grade of PD complications increase hospital cost across diverse settings. The costing methodology should be transparent and complication grading systems should be consistent in future studies. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2017:CRD42017058427.
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Affiliation(s)
- Jason Wang
- Department of Anaesthesia, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Ronald Ma
- Department of Finance, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience & Mental Health, Parkville, VIC 3052, Australia
| | - Paul Eleftheriou
- Deputy Chief Medical Office, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Mehrdad Nikfarjam
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Christopher Christophi
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, VIC 3084, Australia; University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, VIC 3084, Australia.
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6
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Gruppo M, Angriman I, Martella B, Spolverato YC, Zingales F, Bardini R. Perioperative albumin ratio is associated with post-operative pancreatic fistula. ANZ J Surg 2017; 88:E602-E605. [PMID: 29194898 DOI: 10.1111/ans.14262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/18/2017] [Accepted: 09/03/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite improvements in surgical techniques and perioperative management, post-operative pancreatic fistula (POPF) remains a serious complication after pancreaticoduodenectomy (PD). The aim of this study was to evaluate the role of perioperative clinical variables of patients, including albumin level, in predicting pancreatic fistula. METHODS A total of 86 patients underwent PD for pancreas cancer between 2011 and 2017 at our institution. We prospectively investigated the relation between patient's characteristics and the incidence of clinically relevant (CR)-POPF. Perioperative albumin ratio was defined as post-operative day 1 (POD1) albumin level/preoperative albumin level. RESULTS A total of 23 patients (26.7%) developed CR-POPF. At univariate analysis POPF correlated with soft pancreas (P = 0.045), low POD1 albumin (P = 0.02), POD1 and POD3 amylase levels in drainage fluid (P = 0.003 and P = 0.014, respectively) and perioperative albumin ratio (0.58 ± 0.10 versus 0.69 ± 0.12 in patients without POPF; P = 0.003). No significant correlations with POPF were demonstrated for surgical time, serum amylase levels and preoperative albumin levels. At multivariate analysis POD3 amylase level in drainage fluid and perioperative albumin ratio were the only significant independent parameters (P = 0.027 and P = 0.047, respectively). CONCLUSIONS Perioperative albumin ratio can predict POPF after PD.
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Affiliation(s)
- Mario Gruppo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Imerio Angriman
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Bruno Martella
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Ylenia C Spolverato
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesca Zingales
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Romeo Bardini
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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Zijah R, Jasmin H, Amra M, Emir A, Amir T, Goran I. http://www.ijhpd.com/archive/2016-archive/100060IJHPDRZ2016-zijah/100060IJHPDRZ2016-zijah-full-text.php. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2016-59-oa-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aims: The most demanding anastomosis of cephalic pancreaticoduodenectomy is pancreaticojejunostomy. In order to reduce the number of complications of pancreatico- jejunostomy, we worked to improve the technique of creating the anastomosis by modification of several aspects of the already standardized technique of creating a pancreaticojejunostomy.
Materials and Methods: Observational cohort study was conducted on 50 patients who had undergone a cephalic pancreaticoduo-denectomy due to a periampullary carcinoma in the period from January 2011 to March 2016. We analyzed the effect of the presented technique on postoperative morbidity and mortality.
Results: Of the 50 surgical patients, 31 (62%) were male. The mean age of the surgical patients was 58.8±10.08 years. Postoperative morbidity of 28% was lower than figures from literatures, which range from 35–43% (p > 0.05). Postoperative mortality was 6%, and in line with the figures from literature. Postoperative pancreatic fistula occurred in 6% of patients, which is also lower than 12.9% found in literature (p > 0.05).
Conclusion: Postoperative morbidity in patients in whom a pancreaticojejunostomy was created with presented technique, including the incidence of a postoperative pancreatic fistula, was lower, although the difference was not statistically significant.
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Affiliation(s)
- Rifatbegović Zijah
- MD, University Clinical Centre Tuzla, Department of Surgery, Tuzla, Bosnia and Herzegovina
| | - Hasanović Jasmin
- MD, University Clinical Centre Tuzla, Department of Surgery, Tuzla, Bosnia and Herzegovina
| | - Meštrić Amra
- MD, University of Tuzla, School of Medicine, Tuzla, Bosnia and Herzegovina
| | - Ahmetašević Emir
- MD, University Clinical Centre Tuzla, Department of Surgery, Tuzla, Bosnia and Herzegovina
| | - Tursunović Amir
- MD, University Clinical Centre Tuzla, Department of Surgery, Tuzla, Bosnia and Herzegovina
| | - Imamović Goran
- MD, University of Tuzla, School of Medicine, Tuzla, Bosnia and Herzegovina
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Søreide K, Labori KJ. Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review. Scand J Gastroenterol 2016; 51:1147-54. [PMID: 27216233 PMCID: PMC4975078 DOI: 10.3109/00365521.2016.1169317] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. METHODS A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. RESULTS A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. CONCLUSIONS Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, HPB Unit, Stavanger University Hospital,
Stavanger,
Norway,Department of Clinical Medicine, University of Bergen,
Bergen,
Norway,CONTACT Kjetil Søreide
Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100,
N-4068Stavanger,
Norway
| | - Knut Jørgen Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital,
Oslo,
Norway
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