Characterization and Optimal Management of High-risk Pancreatic Anastomoses During Pancreatoduodenectomy

Published on Apr 1, 2018in Annals of Surgery10.13
· DOI :10.1097/SLA.0000000000002327
Brett L. Ecker18
Estimated H-index: 18
(UPenn: University of Pennsylvania),
Matthew T. McMillan23
Estimated H-index: 23
(UPenn: University of Pennsylvania)
+ 35 AuthorsCharles M. Vollmer67
Estimated H-index: 67
(UPenn: University of Pennsylvania)
Sources
Abstract
Objective:The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy.Background:The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circ
📖 Papers frequently viewed together
566 Citations
20073.36Surgery
1,601 Citations
17k Citations
References42
Newest
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2Giuseppe MalleoH-Index: 43
Last. Charles M. VollmerH-Index: 67
view all 13 authors...
Objective:This multicenter study sought to prospectively evaluate a drain management protocol for pancreatoduodenectomy (PD).Background:Recent evidence suggests value for both selective drain placement and early drain removal for PD. Both strategies have been associated with reduced rates of clinica
101 CitationsSource
#1Claudio BassiH-Index: 110
Last. M.W. Büchler (Heidelberg University)H-Index: 79
view all 33 authors...
Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
1,355 CitationsSource
#1Matthew T. McMillanH-Index: 23
#2Sameer Soi (Mayo Clinic)H-Index: 6
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 27 authors...
Objective:To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator.Background:Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of
95 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2John D. Christein (UA: University of Alabama)H-Index: 35
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 12 authors...
Background Differences in the behavior of postoperative pancreatic fistulas (POPF) have been described after various pancreatic resections. Here, we compare POPFs after pancreatoduodenectomy (PD) and distal pancreatectomy (DP) using the average complication burden (ACB), a quantitative measure of complication burden. Methods From 2001 to 2014, 837 DPs and 1,533 PDs were performed by 14 surgeons at 4 institutions. POPFs were categorized by International Study Group on Pancreatic Fistula standards...
59 CitationsSource
#1Tobias KeckH-Index: 41
#2Ulrich F. WellnerH-Index: 30
Last. U. T. HoptH-Index: 7
view all 36 authors...
Objectives:To assess pancreatic fistula rate and secondary endpoints after pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy in the setting of a multicenter randomized controlled trial.Background:PJ and PG are established methods for reconstruction in pancreatoduodenectomy. Recent prospective trials suggest superiority of the PG regarding perioperative complications.Methods:A multicenter prospective randomized controlled trial comparing PG wit...
190 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
Last. Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 29
view all 29 authors...
Introduction International Study Group of Pancreatic Fistula (ISGPF) grade C postoperative pancreatic fistulas (POPF) are the greatest contributor to major morbidity and mortality following pancreatoduodenectomy (PD); however, their infrequent occurrence has hindered deeper analysis. This study sought to develop a predictive algorithm, which could facilitate effective management of this challenging complication.
77 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
#2Giuseppe Malleo (University of Verona)H-Index: 43
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 5 authors...
Abstract Background Pancreatoduodenectomy (PD) is a technically challenging operation characterized by numerous management decisions. Objective This study was designed to test the hypothesis that there is significant variation in the contemporary global practice of PD. Methods A survey with native‐language translation was distributed to members of 22 international gastrointestinal surgical societies. Practice patterns and surgical decision making for PD were assessed. Regions were categorized as...
59 CitationsSource
#1Christopher R. Shubert (Mayo Clinic)H-Index: 12
#2Amy E. Wagie (Mayo Clinic)H-Index: 17
Last. Michael L. Kendrick (Mayo Clinic)H-Index: 58
view all 9 authors...
Background A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. Study Design The CRS-PF was calculated from a retrospective review of patients undergoing PD from January 2007 to February 2014. Postoperative pancreatic fistula was graded using Internat...
69 CitationsSource
#1Prakash Kurumboor (Memorial Hospital of South Bend)H-Index: 3
#2Kamalesh Nadothottam Palaniswami (Memorial Hospital of South Bend)H-Index: 1
Last. Sylesh Aikot (Memorial Hospital of South Bend)H-Index: 2
view all 7 authors...
Background Whether octreotide prevents pancreatic fistula following pancreatoduodenectomy is controversial and it is believed to be beneficial in soft glands and normal-sized ducts. The aim of this study is to assess the potential value of octreotide in reducing the incidence of pancreatic fistula, postoperative complications, morbidity and hospital stay in patients with soft pancreas and non-dilated ducts.
36 CitationsSource
#1Ayman El Nakeeb (Mansoura University)H-Index: 21
#2Mohamed El Hemaly (Mansoura University)H-Index: 5
Last. Mohamed Abd ElWahab (Mansoura University)H-Index: 5
view all 9 authors...
Abstract Background The ideal technical pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debated. The aim of the study was to assess the surgical outcomes of duct to mucosa pancreaticojejunostomy (PJ) (G1) and invagination PJ (G2) after PD. Methods Consecutive patients treated by PD at our center were randomized into either group. The primary outcome measure was the rate of postoperative pancreatic fistula (POPF); secondary outcomes included; operative time, day to resum...
46 CitationsSource
Cited By65
Newest
#2Anan LiuH-Index: 8
Last. Guang YangH-Index: 2
view all 13 authors...
Source
Source
#1Lisa Suzanne Brubaker (BCM: Baylor College of Medicine)H-Index: 2
#2Fabio Casciani (University of Verona)H-Index: 2
Last. Chad G. Ball (U of C: University of Calgary)H-Index: 47
view all 26 authors...
Abstract null null Background null Intraperitoneal drain placement decreases morbidity and mortality in patients who develop a clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD). It is unknown whether multiple drains mitigate CR-POPF better than a single drain. We hypothesize that multiple drains decrease the complication burden more than a single drain in cases at greater risk for CR-POPF. null null null Methods null The Fistula Risk Score (FRS...
Source
#1Yuancong Jiang (ZJU: Zhejiang University)H-Index: 3
#2Qin Chen (LMB: Laboratory of Molecular Biology)H-Index: 1
Last. Sheng Yan (ZJU: Zhejiang University)H-Index: 19
view all 9 authors...
Background: There is no specific evidence regarding the benefits of external and internal pancreatic duct stents after pancreaticoduodenectomy since pancreatic fistula (grade A) have been redefined with no clinical treatment effect. We aimed to reevaluate the prognostic value of external and internal stents in clinically relevant postoperative pancreatic fistula over pancreaticoduodenectomy.Methods: PubMed, Web of Science, EMBASE and the Cochrane Database were specifically searched for pertinent...
1 CitationsSource
#1Roberto Salvia (University of Verona)H-Index: 52
#2Gabriella Lionetto (University of Verona)H-Index: 1
Last. Giovanni Marchegiani (University of Verona)H-Index: 29
view all 5 authors...
Postoperative pancreatic fistula (POPF) still represents the major driver of surgical morbidity after pancreaticoduodenectomy. The purpose of this narrative review was to critically analyze current evidence supporting the use of total pancreatectomy (TP) to prevent the development of POPF in patients with high-risk pancreas, and to explore the role of completion total pancreatectomy (CP) in the management of severe POPF. Considering the encouraging perioperative outcomes, TP may represent a prom...
1 CitationsSource
#1Stefano Andrianello (University of Verona)H-Index: 16
#2Giovanni Marchegiani (University of Verona)H-Index: 29
Last. Roberto Salvia (University of Verona)H-Index: 52
view all 9 authors...
Abstract Background Several advantages and pitfalls have been related to externalized trans-anastomotic stents (ETS) after pancreaticoduodenectomy. The purpose of this study was to investigate the effect of an ETS effect in a risk-stratified setting. Methods Data from patients at either intermediate- or high-risk for postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy were prospectively analyzed from January 2016 to December 2019. Outcomes included POPF rate, mean complicat...
3 CitationsSource
#1Tommaso GiulianiH-Index: 5
Last. Claudio BassiH-Index: 3
view all 4 authors...
Source
#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Claudio Bassi (University of Verona)H-Index: 110
2 CitationsSource
Resumen null null Introduccion null Existe controversia respecto a la tecnica ideal de reconstruccion pancreatico-yeyunal posreseccion duodeno-pancreatica. La tutorizacion externa del Wirsung se ha considerado por muchos autores como una tecnica con menor incidencia de fistulas y morbimortalidad. Analizamos nuestra experiencia con esta tecnica. null null null Pacientes y metodos null Analisis retrospectivo de la morbimortalidad, de una serie de 80 pacientes consecutivos intervenidos, durante 6,5...
1 CitationsSource
Resumen Introduccion Existe controversia respecto a la tecnica ideal de reconstruccion pancreatico-yeyunal posreseccion duodeno-pancreatica. La tutorizacion externa del Wirsung se ha considerado por muchos autores como una tecnica con menor incidencia de fistulas y morbimortalidad. Analizamos nuestra experiencia con esta tecnica. Pacientes y metodos Analisis retrospectivo de la morbimortalidad, de una serie de 80 pacientes consecutivos intervenidos, durante 6,5 anos, por tumores pancreaticos cef...
1 CitationsSource