Impact of possible risk factors on pancreatic fistula development after pancreaticoduodenectomy: Prospective cohort study
Abstract
Aim: The most important complication that develops after pancreaticoduodenectomy is anastomosis leak and pancreatic fistula. Pancreatic fistula is thought to be the cause of major complications such as intra-abdominal abscess. The relationship between the development of fistula after pancreaticoduodenectomy and intraoperative risk factors (resection type, pancreatic anastomosis type, pancreatic duct diameter and pancreatic stump structure), along with the effect of pancreatic fistula on morbidity were investigated.
Methods: Forty-one patients who had undergone pancreaticoduodenectomy due to periampullary region tumors were included in this study. Patients were divided into two groups as with and without pancreatic fistula, and compared in terms of demographics, preoperative serum bilirubin and serum albumin values, and intraoperative risks (resection type, pancreatic anastomosis type, pancreatic duct diameter and pancreatic stump structure). In addition, the groups were evaluated for the development of post-operative complications.
Results: When both groups were compared in terms of intraoperative risk factors (resection type, pancreatic anastomosis type, pancreatic duct diameter and pancreatic stump structure), similar results were obtained for biochemical parameters (P=0.719, 0.599, 0.250, 0.906, respectively). A statistically significant association was found between the occurrence of pancreatic fistula and delay of gastric emptying (P=0.028). No significant relationship was detected between intraabdominal collection-abscess, intraabdominal hemorrhage, wound infection parameters and pancreatic fistula (P=0.204, 0.950, 0.116, respectively).
Conclusion: No factors were found to be solely associated with the development of pancreatic fistula following pancreaticoduodenectomy; however, it was concluded that pancreaticoenteric anastomosis technique and the consistency of pancreatic stump may be closely and significantly related.
References
- 1. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990’s: Pathology, complications and outcomes. Ann Surg 1997;226:248-57.
- 2. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430-8.
- 3. Sakorafas GH, Friess H, Balsiger BM, Buchler MW, Sarr MG. Problems of reconstruction during pancreaticoduodenectomy. Dig Surg. 2001;18:363-9.
- 4. Hoshal VL Jr, Benedict MB, David LR, Kulick J. Personal experience with the Whipple operation: Outcomes and lessons learned. Am Surg. 2004;70:121-5.
- 5. Lillemoe KD. Current management of pancreatic carcinoma. Ann Surg. 1995;2:133-48.
- 6. Stefano C, Roberto S, Massımo F, Gıovannı B, Luca L, Claudio B. Anastomotic leakage in pancreatic surgery. HPB. 2007;9:8-15.
- 7. Duffas JP, Suc B, Msika S, Fourtanier G, Muscari F, Hay JM, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg. 2005;180:720-9.
- 8. Andivot T, Cardoso J, Dousset B, Soubrane O, Bonnichon P, Chapuis Y. Complications of two types of pancreatic anastomosis after pancreaticoduodenectomy. Ann Chir. 1996;50:431-7.
- 9. 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.
- 10. Fang WL, Shyr YM, Su CH, Chen TH, Wu CW, Lui WY. Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodectomy. J. Formos Med Assoc. 2007;106:717-27.
- 11. Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, 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.
- 12. Yeo CJ, Cameron JL. The Pancreas. In: Sabiston DC Jr, Editör. Textbook of Surgery. Philadelphia: WB Saunders Company. 1991;35:1076-105.
- 13. Popiela T, Kedra B, Sierzega M, Gurda A. Risk factors of pancreatic fistula following pancreaticoduodenectomy for periampullary cancer. Hepatogastroenterology. 2004;51:1484-8.
- 14. Kim JH, Yoo BM, Kim JH, Kim WH. Which method should we select for pancreatic anastomosis after pancreaticoduodectomy? World J Surg. 2009;33:326-32.
- 15. Poon RT, Lo SH, Fong D, Fan ST, Wong J. Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am J Surg. 2002;183:42-52.
- 16. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg. 1995;221:635-48.
- 17. Suzuki Y, Fujino Y, Tanioka Y, Hiraoka K, Takada M, Ajiki T, et al. Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size. Arch Surg. 2002;137:1044-8.
Pankreatikoduodenektomi sonrası olası risk faktörlerinin pankreatik fistül gelişimi üzerine etkisi: Prospektif kohort çalışma
Abstract
Amaç: Pankreatikoduodenektomi sonrası gelişen en önemli komplikasyon anastomoz kaçağı ve pankreas fistülüdür. Pankreas fistülünün karın içi apse gibi büyük komplikasyonların nedeni olduğu düşünülmektedir. Pankreatikoduodenektomi sonrası fistül gelişimi ile intraoperatif risk faktörleri (rezeksiyon tipi, pankreatik anastomoz tipi, pankreatik kanal çapı ve pankreatik güdük yapısı) arasındaki ilişki araştırıldı ve pankreatik fistülün morbidite üzerine etkisi araştırıldı.
Yöntemler: Bu çalışmada, periampuller bölge tümörleri nedeni ile pankreatikoduodektomi operasyonu uygulanan 41 hasta incelendi. Hastalar pankreatik anastomoz kaçağı olan ve olmayan olarak iki gruba ayrıldı. Her iki grup yüksek serum bilirübin ve düşük serum albumin değerleri ve intraoperatif riskler (rezeksiyon tipi, pankreatik anastomoz tipi, pankreatik kanal çapı ve pankreatik güdük yapısı) açısından karşılaştırıldı. Ayrıca gruplar post-operatif komplikasyon gelişimi açısından da değerlendirildi. Postoperatif komplikasyonlar: İntraabdominal koleksiyon-apse, intraabdominal hemoraji, yara yeri enfeksiyonu ve mide boşalma süresinin uzaması olarak kabul edildi.
Bulgular: Her iki grup da intraoperatif risk faktörleri (rezeksiyon tipi, pankreatik anastomoz tipi, pankreatik kanal çapı ve pankreatik güdük yapısı) açısından karşılaştırıldığında, biyokimyasal parametreler için benzer sonuçlar elde edilmiştir. (P=0,719, 0,599, 0,250, 0,906 sırasıyla). Gruplar, postoperatif komplikasyon parametreleri ile kıyaslandığında ise pankreatik fistül ile mide boşalma süresinin gecikmesi arasında istatistiksel olarak anlamlılık tespit edildi (P=0,028). İntra-abdominal apse, karın içi kanama, yara enfeksiyonu parametreleri ve pankreatik fistül arasında istatistiksel olarak anlamlı bir fark bulunmadı (sırasıyla P=0,204, 0,950, 0,116).
Sonuç: Pankreatikoduodenektomi sonrası pankreatik fistül gelişmesinde hiçbir faktör tek başına etkili bulunmadı. Ancak belirgin bir şekilde pankreatikoenterik anastomoz tekniği ve pankreatik güdüğün kıvamı ile yakından ilişkili olabileceği kanaatine varıldı.
References
- 1. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990’s: Pathology, complications and outcomes. Ann Surg 1997;226:248-57.
- 2. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430-8.
- 3. Sakorafas GH, Friess H, Balsiger BM, Buchler MW, Sarr MG. Problems of reconstruction during pancreaticoduodenectomy. Dig Surg. 2001;18:363-9.
- 4. Hoshal VL Jr, Benedict MB, David LR, Kulick J. Personal experience with the Whipple operation: Outcomes and lessons learned. Am Surg. 2004;70:121-5.
- 5. Lillemoe KD. Current management of pancreatic carcinoma. Ann Surg. 1995;2:133-48.
- 6. Stefano C, Roberto S, Massımo F, Gıovannı B, Luca L, Claudio B. Anastomotic leakage in pancreatic surgery. HPB. 2007;9:8-15.
- 7. Duffas JP, Suc B, Msika S, Fourtanier G, Muscari F, Hay JM, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg. 2005;180:720-9.
- 8. Andivot T, Cardoso J, Dousset B, Soubrane O, Bonnichon P, Chapuis Y. Complications of two types of pancreatic anastomosis after pancreaticoduodenectomy. Ann Chir. 1996;50:431-7.
- 9. 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.
- 10. Fang WL, Shyr YM, Su CH, Chen TH, Wu CW, Lui WY. Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodectomy. J. Formos Med Assoc. 2007;106:717-27.
- 11. Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, 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.
- 12. Yeo CJ, Cameron JL. The Pancreas. In: Sabiston DC Jr, Editör. Textbook of Surgery. Philadelphia: WB Saunders Company. 1991;35:1076-105.
- 13. Popiela T, Kedra B, Sierzega M, Gurda A. Risk factors of pancreatic fistula following pancreaticoduodenectomy for periampullary cancer. Hepatogastroenterology. 2004;51:1484-8.
- 14. Kim JH, Yoo BM, Kim JH, Kim WH. Which method should we select for pancreatic anastomosis after pancreaticoduodectomy? World J Surg. 2009;33:326-32.
- 15. Poon RT, Lo SH, Fong D, Fan ST, Wong J. Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am J Surg. 2002;183:42-52.
- 16. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg. 1995;221:635-48.
- 17. Suzuki Y, Fujino Y, Tanioka Y, Hiraoka K, Takada M, Ajiki T, et al. Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size. Arch Surg. 2002;137:1044-8.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research article |
| Authors | |
| Publication Date | March 1, 2020 |
| Published in Issue | Year 2020 Volume: 4 Issue: 3 |
