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Rozhledy V Chirurgii : Mesicnik... Feb 2013Pancreatic fistula is a common complication after pancreatic resections. Its incidence oscillates between 10 and 30%. The differences in the incidence cited in the... (Review)
Review
Pancreatic fistula is a common complication after pancreatic resections. Its incidence oscillates between 10 and 30%. The differences in the incidence cited in the studies are due to the various fistula definitions. According to ISGPF, pancreatic fistula is an output -via an operatively placed drain (or a subsequently placed percutaneous drain) - of any measurable volume of drain fluid on or after postoperative day 3, with an amylase content higher than 3 times the upper normal serum value. The fistula is then classified according to the clinical impact in grades A, B, and C. There are known three risk factor categories for the development of pancreatic fistula: the risk related to the pancreatic disease, to the patient, and to the surgical procedure. Most of the risk factors for the development of pancreatic fistula cannot be influenced either prior to or during the surgery. There are two basic options for the prevention of pancreatic fistula: pharmacological intervention (administration of somatostatin and its analogues) and technical modifications of the pancreatic remnant treatment. However, the routine administration of somatostatin and its analogues is not advisable in all pancreatic surgical procedures. In high risk cases the selective administration is preferred. The second option is modification of pancreatic remnant treatment. Most of the studies dealing with various modifications of the pancreatic remnant treatment were retrospective with lower level of evidence. There were only a few properly designed randomized trials, and most of them did not prove benefit of one method over another. It has been shown that the results depend on the experience of a given surgical department, and above all on the experience of an individual surgeon who performs the pancreatic resection. The therapy of pancreatic fistula is based on the clinical severity. Conservative approach is warranted in most patients. In cases when reoperation is required, there are two basic strategies: surgical drainage of the collections, and completion of total pancreatectomy. Total pancreatectomy was preferred in the past, however, this procedure is technically very demanding with mortality up to 80 per cent. Nowadays, most of the authors prefer surgical drainage; this procedure is technically less demanding, has lower mortality, the endocrine function of pancreas is protected, and the patients usually need no further interventions.
Topics: Humans; Pancreatic Fistula; Risk Factors
PubMed: 23578342
DOI: No ID Found -
The American Surgeon Mar 2011Postoperative pancreatic fistula (POPF) is the most frequent complication after pancreaticoduodenectomy, results in increased morbidity and mortality, and adversely... (Review)
Review
Postoperative pancreatic fistula (POPF) is the most frequent complication after pancreaticoduodenectomy, results in increased morbidity and mortality, and adversely affects length of stay and costs. Reported rates of postoperative pancreatic fistula vary from 0 per cent up to more than 30 per cent. Plenty of randomized trails and meta-analysis were published to analyze the ideal procedure, technique of anastomosis, and perioperative management of patients undergoing pancreaticoduodenectomy; however, results are often discordant and clear evidence on the ideal management and surgical technique to reduce POPF rate is not yet provided. This collective review examined the current evidence about risk factors contributing to postoperative pancreatic fistula and delineates methods of diagnosis and treatment of this universally dreaded complication.
Topics: Female; Humans; Male; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Risk Factors
PubMed: 21375833
DOI: No ID Found -
HPB : the Official Journal of the... Aug 2021Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fistula definition.
BACKGROUND
Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016 International Study Group of Pancreatic Fistula (ISGPF) definition.
METHODS
A systemic search of MEDLINE, Pubmed, Scopus, and EMBASE were conducted using the PRISMA framework. Studies were evaluated for risk factors for the development CR-POPF after DP using the 2016 ISGPF definition. Further subgroup analysis was undertaken on studies ≥10 patients in exposed and non-exposed subgroups.
RESULTS
Forty-three studies with 8864 patients were included in the meta-analysis. The weighted rate of CR-POPF was 20.4% (95%-CI: 17.7-23.4%). Smoking (OR 1.29, 95%-CI: 1.08-1.53, p = 0.02) and open DP (OR 1.43, 95%-CI: 1.02-2.01, p = 0.04) were found to be significant risk factors of CR-POPF. Diabetes (OR 0.81, 95%-CI: 0.68-0.95, p = 0.02) was a significant protective factor against CR-POPF. Substantial heterogeneity was observed in the comparisons of pancreatic texture and body mass index. Seventeen risk factors achieved significance in a univariate or multivariate comparison as reported by individual studies in the narrative synthesis, however, they remain difficult to interpret as statistically significant comparisons were not uniform.
CONCLUSION
This meta-analysis found smoking and open DP to be risk factors and diabetes to be protective factor of CR-POPF in the era of 2016 ISGPF definition.
Topics: Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 33820687
DOI: 10.1016/j.hpb.2021.02.015 -
HPB : the Official Journal of the... Nov 2015A post-operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all... (Review)
Review
BACKGROUND
A post-operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all scoring systems to predict POPF after a PD, consider their clinical applicability and assess the study quality.
METHOD
An electronic search was performed of Medline (1946-2014) and EMBASE (1996-2014) databases. Results were screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and quality assessed according to the QUIPS (quality in prognostic studies) tool.
RESULTS
Six eligible scoring systems were identified. Five studies used the International Study Group on Pancreatic Fistula (ISGPF) definition. The proposed scores feature between two and five variables and of the 16 total variables, the majority (12) featured in only one score. Three scores could be fully completed pre-operatively whereas 1 score included intra-operative and two studies post-operative variables. Four scores were internally validated and of these, two scores have been subject to subsequent multicentre review. The median QUIPS score was 38 out of 50 (range 16-50).
CONCLUSION
These scores show potential in calculating the individualized patient risk of POPF. There is, however, much variation in current scoring systems and further validation in large multicentre cohorts is now needed.
Topics: Global Health; Humans; Incidence; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Prognosis; Risk Assessment; Risk Factors
PubMed: 26456948
DOI: 10.1111/hpb.12503 -
Surgery Jun 2022Previous studies reported a higher rate of postoperative pancreatic fistula after minimally invasive distal pancreatectomy compared to open distal pancreatectomy. It is... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Previous studies reported a higher rate of postoperative pancreatic fistula after minimally invasive distal pancreatectomy compared to open distal pancreatectomy. It is unknown whether the clinical impact of postoperative pancreatic fistula after minimally invasive distal pancreatectomy is comparable with that after open distal pancreatectomy. We aimed to compare not only the incidence of postoperative pancreatic fistula, but more importantly, also its clinical impact.
METHODS
This is a post hoc analysis of a multicenter randomized trial investigating a possible beneficial impact of a fibrin patch on the rate of clinically relevant postoperative pancreatic fistula (International Study Group for Pancreatic Surgery grade B/C) after distal pancreatectomy. Primary outcomes of the current analysis are the incidence and clinical impact of postoperative pancreatic fistula after both minimally invasive distal pancreatectomy and open distal pancreatectomy.
RESULTS
From October 2010 to August 2017, 252 patients undergoing distal pancreatectomy were randomized, and data of 247 patients were available for analysis: 87 minimally invasive distal pancreatectomy and 160 open distal pancreatectomies. The postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was significantly higher than that after open distal pancreatectomy (28.7% vs 16.9%, P = .029). More patients were discharged with an abdominal surgical drain after minimally invasive distal pancreatectomy compared to open distal pancreatectomy (30/87, 34.5% vs 26/160, 16.5%, P = .001). In patients with postoperative pancreatic fistula, additional percutaneous catheter drainage procedures were performed less often (52% vs 84.6%, P = .012), with fewer drainage procedures (median [range], 2 [1-4] vs 2, [1-7], P = .014) after minimally invasive distal pancreatectomy.
CONCLUSION
In this post hoc analysis, the postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was higher than that after open distal pancreatectomy, whereas the clinical impact was less.
Topics: Humans; Incidence; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34906371
DOI: 10.1016/j.surg.2021.11.009 -
Surgery Dec 2023Fistula risk scores such as distal fistula risk scores and DISPAIR have been recently developed to assess the risk of clinically relevant postoperative pancreatic...
BACKGROUND
Fistula risk scores such as distal fistula risk scores and DISPAIR have been recently developed to assess the risk of clinically relevant postoperative pancreatic fistula after distal pancreatectomy. This study aimed to validate these models externally using a large-scale Chinese cohort.
METHODS
The study enrolled adult patients who underwent distal pancreatectomy at a high-volume single center between January 2011 and December 2021. The clinically relevant postoperative pancreatic fistula was defined as grade B/C, according to the 2016 International Study Group of Pancreatic Surgery. Model performance was evaluated using the area under the curve.
RESULTS
Among 653 eligible patients, 126 (19.3%) suffered from clinically relevant postoperative pancreatic fistulas. Independent predictors for clinically relevant postoperative pancreatic fistulas included body mass index, diabetes mellitus, pancreatic thickness at both neck and transection sites, main pancreatic duct diameter, and soft pancreas. Clinically relevant postoperative pancreatic fistula risk increased with increasing score severity. All 3 prediction models showed acceptable discrimination, with area under the curve values of preoperative distal fistula risk score at 0.723 (95% confidence interval 0.687-0.757), intraoperative distal fistula risk score at 0.737 (95% confidence interval 0.701-0.770), and DISPAIR at 0.721 (95% confidence interval 0.685-0.755). No significant differences were found among them.
CONCLUSION
Distal fistula risk scores and DISPAIR are useful tools for predicting clinically relevant postoperative pancreatic fistula after distal pancreatectomy, highlighting their importance in guiding surgical approach decisions and mitigating strategies against this complication in clinical practice.
Topics: Adult; Humans; Pancreatic Fistula; Pancreatectomy; Pancreas; Risk Factors; Postoperative Complications
PubMed: 37827899
DOI: 10.1016/j.surg.2023.09.007 -
World Journal of Surgery Aug 2022There is no consensus on the pancreatic transection during distal pancreatectomy (DP) to reduce postoperative pancreatic fistula (POPF). This meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is no consensus on the pancreatic transection during distal pancreatectomy (DP) to reduce postoperative pancreatic fistula (POPF). This meta-analysis aimed to evaluate the effects of a reinforced stapler on the postoperative outcomes of DP.
METHODS
We systematically searched electronic databases and bibliographic reference lists in The PubMed/MEDLINE, Google Scholar, Cochrane Library's Controlled Trials Registry and Database of Systematic Reviews, Embase, and Scopus. Review Manager Software was used for pooled estimates.
RESULTS
Seven eligible studies published between 2007 and 2021 were included with 553 patients (267 patients in the reinforced stapler group and 286 patients in the standard stapler group). The reinforced stapler reduced the POPF grade B and C (OR = 0.33; 95% CI [0.19, 0.57], p < 0.01). There was no difference between the reinforced stapler group and standard stapler group in terms of mortality rate (OR = 0.39; 95% CI [0.04, 3.57], p = 0.40), postoperative haemorrhage (OR = 0.53; 95% CI [0.20, 1.43], p = 0.21), and reoperation rate (OR = 0.91; 95% CI [0.40, 2.06], p = 0.82).
CONCLUSIONS
Reinforced stapling in DP is safe and seems to reduce POPF grade B/C with similar mortality rates, postoperative bleeding, and reoperation rate. The protocol of this systematic review with meta-analysis was registered in PROSPERO (ID: CRD42021286849).
Topics: Humans; Incidence; Pancreas; Pancreatectomy; Pancreatic Fistula; Postoperative Complications; Risk Factors
PubMed: 35525852
DOI: 10.1007/s00268-022-06572-3 -
HPB : the Official Journal of the... Sep 2012In 2005 the International Study Group for Pancreatic Fistula (ISGPF) created a definition and grading system for pancreatic fistulae (PF) in which grade C denotes the... (Review)
Review
BACKGROUND
In 2005 the International Study Group for Pancreatic Fistula (ISGPF) created a definition and grading system for pancreatic fistulae (PF) in which grade C denotes the most severe and potentially life-threatening type. Factors and outcomes associated with grade C fistulae have been ill defined.
METHODS
Systematic searches of PubMed and EMBASE were conducted by two independent reviewers utilizing the keywords 'pancreaticoduodenectomy' (PD) and 'pancreatic fistula'. Inclusion criteria were: (i) a sample of ≥100 patients; (ii) consecutive accrual of all pathologies, and (iii) use of the ISGPF definition and grading system. Quality appraisal and data extraction were performed using pilot-tested templates.
RESULTS
Fourteen articles describing a total of 2706 PDs met the study entrance criteria. Pancreatic fistulae occurred in 479 patients (18%) and included 71 grade C PF that were directly responsible for 25 deaths (35% mortality rate). Only two studies analysed risk factors; these found soft pancreatic texture and histology other than adenocarcinoma to be the most common risk factors. Ten studies reported management strategies and indicated that 51% of patients required reoperation.
CONCLUSIONS
Grade C PF: (i) accounts for 15% of fistulae following PD and has an associated mortality rate of 35%; (ii) occurs most commonly in pathology associated with a soft remnant, and (iii) requires reoperation in approximately one half of patients. The published literature incompletely describes grade C PF.
Topics: Humans; Incidence; Pancreatic Fistula; Pancreaticoduodenectomy; Reoperation; Risk Assessment; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 22882195
DOI: 10.1111/j.1477-2574.2012.00486.x -
Der Chirurg; Zeitschrift Fur Alle... Jun 2015The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication... (Review)
Review
The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication varies between 3 % after pancreatic head resection and up to 35 % following distal pancreatectomy. In 2005, the international definition of postoperative pancreatic fistula was standardized according to the approach of the International Study Group of Pancreatic Surgery (ISGPS) including an A-C grading system of the severity. Consequently, results from different studies have become comparable and the historically reported fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, fistula-associated complications and management of postoperative pancreatic fistula.
Topics: Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Reoperation; Risk Factors
PubMed: 25986674
DOI: 10.1007/s00104-015-0003-2 -
American Journal of Surgery Feb 1992Internal pancreatic fistulae are well-recognized complications of inflammatory pancreatic disease. From 1963 to 1990, 50 patients with either pancreatic ascites (34),...
Internal pancreatic fistulae are well-recognized complications of inflammatory pancreatic disease. From 1963 to 1990, 50 patients with either pancreatic ascites (34), pancreatic ascites and pleural effusion (7), or pancreatic pleural effusion (9) were treated. Initial therapy was conservative, consisting of gastrointestinal rest, serosal apposition with paracentesis or thoracentesis, with or without the administration of anti-secretagogues. This therapy was successful in 21 of 42 patients, but 5 deaths occurred. Operative therapy was performed in 24 patients. There was one surgical failure and two deaths early in the experience. Ten of our final 16 patients underwent liver biopsy, and all 10 were found to have cirrhosis. All patients, even those with documented cirrhosis, should have routine amylase and albumin determinations on ascitic or pleural fluid. Internal pancreatic fistulae should be treated initially nonoperatively; if this is ineffective, operative therapy has an acceptably low morbidity and mortality.
Topics: Adolescent; Adult; Aged; Ascites; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Pancreatic Fistula; Pleural Effusion
PubMed: 1739176
DOI: 10.1016/0002-9610(92)90104-y