Abstract
References
- Turhan VB, Dikmen K, Kerem M. The effect of hospital volume on mortality, morbidity and dissected lymph nodes in pancreaticoduodenectomy for periampullary region tumors. J Surg Med 2022; 6: 263-7.
- Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935; 102: 763-79.
- Ambromovage AM, Pairent FW, Howard JM. Pancreatic exocrine insufficiency. V. The effects of long-term pancreatic duct ligation on serum insulin levels and glucose metabolism in the dog. Ann Surg 1973; 177: 338-43.
- DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006; 244: 931-9.
- Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232: 419-29.
- Poon RT, Fan ST, Lo CM, et al. External drainage of the pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007; 246: 425-35.
- BassiC. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surg 2005; 138: 8-13.
- Kawaida H, Kono H, Hosomura N, et al. Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. World J Gastroenterol 2019: 25; 3722.
- Eshmuminov, D, Schneider MA, Tschuor C, et al. Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture. Hpb 2018; 20: 992-1003.
- Brooks AD, Marcus SG, Gradek C, et al. Decreasing length ofstay afterpancreatoduodenectomy. Arch Surg 2000; 135: 823–30.
- Wellner UF, Kulemann B, Lapshyn H, et al. Post pancreatectomy hemorrhage—incidence, treatment, and risk factors in over 1,000 pancreatic resections. Gastrointest Surg 2014;18: 464-75.
- Asai K, Zaydfudim V, Truty M, et al. Management of a delayedpost-pancreatoduodenectomy haemorrhage using endovascular techniques. HPB (Oxford) 2015;17:902–8.
- Miller BC, Christein JD, Behrman SW, et al. A Multi-Institutional External Validation of the Fistula Risk Score for Pancreatoduodenectomy. J Gastrointest Surg 2015; 18: 172–80.
- Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 2013; 216: 1–14.
- Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 2008; 32:419–28.
- Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surg 2017; 161: 584–91.
- Yeo CJ, Cameron JL, Lillemoe KD et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232: 419–29.
- Ke Z, Cui J, Hu N, et al. Risk factors for postoperative pancreatic fistula: Analysis of 170 consecutive cases of pancreaticoduodenectomy based on the updated ISGPS classification and grading system. Medicine (Baltimore) 2018 ; 97: e12151.
- Rivas L, Zettervall SL, Ju T, et al. The Effect of Pancreaticojejunostomy Technique on Fistula Formation Following Pancreaticoduodenectomy in the Soft Pancreas. J Gastrointest Surg 2019; 23: 2211–5.
- Lee SE, Jang J, Lim C, et al. Measurement of pancreatic fat by magnetic resonance imaging. Ann Surg 2010;251: 932–6.
- Mazzaferro V, Virdis M, Sposito C, et al. Permanent Pancreatic Duct Occlusion With Neoprene-based Glue Injection After Pancreatoduodenectomy at High Risk of Pancreatic Fistula: A Prospective Clinical Study. Ann Surg 2019; 270: 791-8.
- van Berge Henegouwen MI, De Wit LT, Van Gulik TM, Obertop H, Gouma DJ.Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg 1997; 185:18–24.
- Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 2005; 11: 2456– 61.
- Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 2008; 32:419-28.
The effect of duct width and pancreatic gland structure on pancreatic fistula rates in patients who underwent pancreaticoduodenectomy for pancreatic cancer
Abstract
Introduction: One of the most important causes of morbidity in pancreaticoduodenectomy (PD) surgery is pancreatic anastomosis leakage. There is a possibility of pancreatic fistula even in the most experienced hands. After PD, pancreatic fistula occurs between 10% and 20% in various series. This study aims to evaluate the effects of pancreatic duct size and pancreatic tissue on the development of pancreatic fistula after PD is performed in our center.
Material and Method: Pancreatic duct size was categorized as small <3 mm and large >3 mm. Pancreatic gland tissue was categorized as a soft, medium, and hard. These variables were calculated preoperatively with the help of computed tomography (CT), ultrasonography(USG), and Endoscopic ultrasound (EUS), and postoperative pathology results. It was accepted that the 24-hour flow rate of the drain behind the pancreatic anastomosis was more than 50 ml during 3 days after PD and/or the amylase concentration of the drain content measured at 3 different times was 3 times higher than the serum amylase concentration.
Results: A total of 90 patients were included in the study, anastomotic leakage was not observed in 63 (70%) of 90 patients, and leakage was observed in 27 (30%) patients. The mean age was 71.22±10.78 years (p=0.615). There was no statistically significant difference between the ductus diameters between the two groups (p=0.240). There was no statistical difference between the groups formed according to pancreatic duct width. (p=0.059). It was observed that 60.3% of the patients in the non-leakage group had a hard appearance, and this rate was statistically significantly reduced to 29.6% in the patients with leakage (p=0.008).
Conclusion: In summary, our study showed that pancreatic fistula after PD is associated with soft pancreatic parenchyma. The surgeon should consider this risk factor when performing a PD and be more careful to reduce the rate of pancreatic fistula.
References
- Turhan VB, Dikmen K, Kerem M. The effect of hospital volume on mortality, morbidity and dissected lymph nodes in pancreaticoduodenectomy for periampullary region tumors. J Surg Med 2022; 6: 263-7.
- Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935; 102: 763-79.
- Ambromovage AM, Pairent FW, Howard JM. Pancreatic exocrine insufficiency. V. The effects of long-term pancreatic duct ligation on serum insulin levels and glucose metabolism in the dog. Ann Surg 1973; 177: 338-43.
- DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006; 244: 931-9.
- Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232: 419-29.
- Poon RT, Fan ST, Lo CM, et al. External drainage of the pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007; 246: 425-35.
- BassiC. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surg 2005; 138: 8-13.
- Kawaida H, Kono H, Hosomura N, et al. Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. World J Gastroenterol 2019: 25; 3722.
- Eshmuminov, D, Schneider MA, Tschuor C, et al. Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture. Hpb 2018; 20: 992-1003.
- Brooks AD, Marcus SG, Gradek C, et al. Decreasing length ofstay afterpancreatoduodenectomy. Arch Surg 2000; 135: 823–30.
- Wellner UF, Kulemann B, Lapshyn H, et al. Post pancreatectomy hemorrhage—incidence, treatment, and risk factors in over 1,000 pancreatic resections. Gastrointest Surg 2014;18: 464-75.
- Asai K, Zaydfudim V, Truty M, et al. Management of a delayedpost-pancreatoduodenectomy haemorrhage using endovascular techniques. HPB (Oxford) 2015;17:902–8.
- Miller BC, Christein JD, Behrman SW, et al. A Multi-Institutional External Validation of the Fistula Risk Score for Pancreatoduodenectomy. J Gastrointest Surg 2015; 18: 172–80.
- Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 2013; 216: 1–14.
- Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 2008; 32:419–28.
- Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surg 2017; 161: 584–91.
- Yeo CJ, Cameron JL, Lillemoe KD et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232: 419–29.
- Ke Z, Cui J, Hu N, et al. Risk factors for postoperative pancreatic fistula: Analysis of 170 consecutive cases of pancreaticoduodenectomy based on the updated ISGPS classification and grading system. Medicine (Baltimore) 2018 ; 97: e12151.
- Rivas L, Zettervall SL, Ju T, et al. The Effect of Pancreaticojejunostomy Technique on Fistula Formation Following Pancreaticoduodenectomy in the Soft Pancreas. J Gastrointest Surg 2019; 23: 2211–5.
- Lee SE, Jang J, Lim C, et al. Measurement of pancreatic fat by magnetic resonance imaging. Ann Surg 2010;251: 932–6.
- Mazzaferro V, Virdis M, Sposito C, et al. Permanent Pancreatic Duct Occlusion With Neoprene-based Glue Injection After Pancreatoduodenectomy at High Risk of Pancreatic Fistula: A Prospective Clinical Study. Ann Surg 2019; 270: 791-8.
- van Berge Henegouwen MI, De Wit LT, Van Gulik TM, Obertop H, Gouma DJ.Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg 1997; 185:18–24.
- Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 2005; 11: 2456– 61.
- Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 2008; 32:419-28.
Details
| Primary Language | English |
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| Subjects | Health Care Administration |
| Journal Section | Original Article |
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| Publication Date | September 25, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 5 |
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