Predictors of pancreatic fistula healing time after distal pancreatectomy

Published on Oct 15, 2020in Journal of Hepato-biliary-pancreatic Sciences4.16
· DOI :10.1002/JHBP.843
Stefano Andrianello16
Estimated H-index: 16
(University of Verona),
Giovanni Marchegiani29
Estimated H-index: 29
(University of Verona)
+ 5 AuthorsClaudio Bassi110
Estimated H-index: 110
(University of Verona)
Sources
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) is common after distal pancreatectomy (DP). Whilst extensive investigation into potential predictors has been carried out, there is little evidence regarding POPF healing time. METHODS This is a retrospective analysis of all consecutive DPs performed at the Department of General and Pancreatic Surgery, University of Verona Hospital Trust, from 2015 to 2019. Perioperative variables were analyzed identifying possible predictors of POPF healing time defined as days between surgery and last drain removal due to POPF. RESULTS A total of 496 patients were included. POPF rate was 28.2% and median POPF healing time was 30 days (95% CI 28-31). Independent predictors of POPF were body mass index (BMI) (OR 1.073, 95% CI 1.010-1.147, p = 0.040), operative time (OR 95% CI 1.002-1.009, P = .003), and postoperative acute pancreatitis (OR 3.793, 95% CI, 1.852-7.767, P < .001). Independent predictors of POPF healing time were female sex (HR 1.323, 95% CI 1.093-1.998, P = .042), preoperative pancreatic enzyme replacement therapy (HR 2.319, 95% CI 1.195-4.498, P = .013), ASA score 3 (HR 0.278, 95% CI 0.119-0.646, P = .003), pancreatic transection with ultrasonic dissector (HR 0.605, 95% CI 0.404-0.907, P = .015), and positive drain cultures (HR 0.635, 95% CI 0.443-0.910, P = .013). CONCLUSION POPF healing after DP is a slow process since only half of patients recover within 30 days of surgery. A longer healing time can be predicted early in the postoperative period with significant implications in therapeutic choices.
References27
Newest
#3Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
#4Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
Last. Markus W. Büchler (Heidelberg University)H-Index: 173
view all 9 authors...
Abstract Background The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines. Methods Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the l...
15 CitationsSource
#1Salvatore Paiella (University of Verona)H-Index: 23
#2Matteo De Pastena (University of Verona)H-Index: 12
Last. Roberto Salvia (University of Verona)H-Index: 52
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Background: The Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking. Methods: Multicenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients wi...
11 CitationsSource
#1Naru Kondo (Hiroshima University)H-Index: 21
#2Kenichiro Uemura (Hiroshima University)H-Index: 35
Last. Yoshiaki Murakami (Hiroshima University)H-Index: 42
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Background Although distal pancreatectomy (DP) using a reinforced stapler is expected to reduce PF, no multicenter RCT has been performed. To investigate whether reinforced staplers reduce the incidence of clinically relevant pancreatic fistula (PF) after DP compared with staplers without reinforcement.
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#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Giampaolo Perri (University of Verona)H-Index: 9
Last. Claudio Bassi (University of Verona)H-Index: 110
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Abstract Background Policies concerning the management of operatively placed drains after pancreatic surgery are still under debate. Open passive drains and closed-suction drains are both used currently in clinical practice worldwide, but there are no reliable data regarding potential differences in the postoperative outcomes associated with each drain type. The aim of the present study was to compare open passive drains and closed-suction drains with regard to postoperative contamination of the...
13 CitationsSource
#1Yasunari Fukuda (Osaka University)H-Index: 9
#2Daisaku Yamada (Osaka University)H-Index: 17
Last. Yuichiro Doki (Osaka University)H-Index: 90
view all 11 authors...
Purpose A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP.
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#1Claudio BassiH-Index: 110
Last. M.W. Büchler (Heidelberg University)H-Index: 79
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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...
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#1Jin-Young Jang (Seoul National University Hospital)H-Index: 54
#2Yong Chan Shin (Seoul National University Hospital)H-Index: 8
Last. Sun Whe Kim (Seoul National University Hospital)H-Index: 43
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Importance The rate of postoperative pancreatic fistula (POPF) after distal pancreatectomy ranges from 13% to 64%. To prevent POPF, polyglycolic acid (PGA) mesh was introduced, but its effect has been evaluated only in small numbers of patients and retrospective studies. Objective To evaluate the efficacy of PGA mesh in preventing POPF after distal pancreatectomy. Design, Setting, and Participants Prospective randomized clinical, single-blind (participant), parallel-group trial at 5 centers betw...
45 CitationsSource
#1Ye Rim Chang (DU: Dankook University)H-Index: 17
#2Jae Seung Kang (Seoul National University Hospital)H-Index: 23
Last. Sun Whe Kim (Seoul National University Hospital)H-Index: 43
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Background Postoperative pancreatic fistula (POPF) is one of the most common and clinically relevant complications after distal pancreatectomy (DP), occurring in 5–40% of patients. Determining risk factors for this complication may aid in its prevention. This study sought to predict the development of POPF after DP preoperatively and objectively based on radiologic findings.
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#1Christopher R. Shubert (Mayo Clinic)H-Index: 12
#2C.R. Ferrone (Harvard University)H-Index: 3
Last. Florencia G. Que (Mayo Clinic)H-Index: 51
view all 8 authors...
Abstract Background Pancreatic leak is common after distal pancreatectomy. This trial sought to compare TissueLink closure of the pancreatic stump to that of SEAMGUARD. Methods A multicenter, prospective, trial of patients undergoing distal pancreatectomy randomized to either TissueLink or SEAMGUARD. Results Enrollment was closed early due to poor accrual. Overall, 67 patients were enrolled, 35 TissueLink and 32 SEAMGUARD. The two groups differed in American Society of Anesthesiologist class and...
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#1Saxon Connor (Christchurch Hospital)H-Index: 34
Introduction Post-operative pancreatic fistula has been well defined. However the underlying aetiology remains poorly understood. The aim of this review was to investigate whether the underlying aetiology for a proportion of patients suffering from post-operative pancreatic fistula was due to post-operative pancreatitis.
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The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy. Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection...
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