The Oncologic Impact of Pancreatic Fistula After Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma of the Body and the Tail: A Multicenter Retrospective Cohort Analysis

Published on Nov 6, 2020in Annals of Surgical Oncology4.061
· DOI :10.1245/S10434-020-09310-Y
Piera Leon3
Estimated H-index: 3
(University of Montpellier),
Fabio Giannone2
Estimated H-index: 2
(University of Montpellier)
+ 16 AuthorsFabrizio Panaro21
Estimated H-index: 21
(University of Montpellier)
The aim of this study was to assess the impact of clinically relevant postoperative pancreatic fistula (CR-POPF) on patient disease-specific survival and recurrence after curative distal pancreatectomy (DP) for pancreatic cancer. This was a retrospective case-control analysis. We examined the data of adult patients with a diagnosis of pancreatic ductal adenocarcinoma (PDAC) of the body and tail of the pancreas undergoing curative DP, over a 10-year period in 12 European surgical departments, from a prospectively implemented database. Among the 382 included patients, 283 met the strict inclusion criteria; 139 were males (49.1%) and the median age of the entire population was 70 years (range 37–88). A total of 121 POPFs were observed (42.8%), 42 (14.9%) of which were CR-POPFs. The median follow-up period was 24 months (range 3–120). Although poorer in the POPF group, overall survival (OS) and disease-free survival (DFS) did not differ significantly between patients with and without CR-POPF (p = 0.224 and p = 0.165, respectively). CR-POPF was not significantly associated with local or peritoneal recurrence (p = 0.559 and p = 0.302, respectively). A smaller percentage of patients benefited from adjuvant chemotherapy after POPF (76.2% vs. 83.8%), but the difference was not significant (p = 0.228). CR-POPF is a major complication after DP but it did not affect the postoperative therapeutic path or long-term oncologic outcomes. CR-POPF was not a predictive factor for disease recurrence and was not associated with an increased incidence of peritoneal or local relapse. ID: NCT04348084
#1Uri Neeman (TAU: Tel Aviv University)H-Index: 1
#2Guy Lahat (TAU: Tel Aviv University)H-Index: 31
Last. Nir Lubezky (TAU: Tel Aviv University)H-Index: 17
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Abstract Background The influence of postoperative complications, specifically, pancreatic fistula (PF), on long-term oncologic outcome in patients with pancreatic ductal adenocarcinoma (PDAC) is unclear. Methods Prospectively collected data of patients who underwent pancreaticoduodenectomy (PD) for PDAC between 2008 and 2016 were retrospectively reviewed and analyzed. Deaths within 90 days were excluded. Median follow-up time was 22 months for the entire cohort (range 2–102 months). PF was grad...
2 CitationsSource
#1Riaz AghaH-Index: 34
#2Ali Abdall-Razak (Imperial College London)H-Index: 2
Last. M. Hammad AtherH-Index: 18
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Abstract Introduction The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication. Methods A steering group was formed to review the existing guideline and propose amendments to the 17-item checklist. A Delphi consensus exercise was utilised to determine agreement across a list of proposed modifications to the STROCSS 2017 guideline. An e...
453 CitationsSource
#1Chathura B. B. Ratnayake (University of Auckland)H-Index: 3
#1Chathura Bb. Ratnayake (University of Auckland)H-Index: 1
Last. Sanjay Pandanaboyana (Freeman Hospital)H-Index: 15
view all 6 authors...
BACKGROUND: The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy remains high, and different pancreatic stump closure techniques have been used to reduce the incidence. A network meta-analysis was undertaken to compare the most frequently performed pancreatic stump closure techniques after distal pancreatectomy and determine the technique associated with the lowest POPF rate. METHODS: A systematic search of the Scopus, PubMed, MEDLINE and Embase databases was cond...
13 CitationsSource
#1Thomas Hank (Harvard University)H-Index: 11
#2Marta Sandini (Harvard University)H-Index: 15
Last. Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
view all 9 authors...
Importance In the past decade, the use of neoadjuvant therapy (NAT) has increased for patients with borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Data on pancreatic fistula and related overall survival (OS) in this setting are limited. Objective To compare postoperative complications in patients undergoing either upfront resection or pancreatectomy following NAT, focusing on clinically relevant postoperative pancreatic fistula (CR-POPF) and potential associations with ...
25 CitationsSource
#1Marta Sandini (Harvard University)H-Index: 15
#2Katarina J. Ruscic (Harvard University)H-Index: 5
Last. Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
view all 8 authors...
Background Postoperative major morbidity has been associated with worse survival gastrointestinal tumors. This association remains controversial in pancreatic cancer (PC). We analyzed whether major complications after surgical resection affect long-term survival.
12 CitationsSource
#1Leah K. Winer (University of Cincinnati Academic Health Center)H-Index: 9
#2Vikrom K. Dhar (University of Cincinnati Academic Health Center)H-Index: 11
Last. Sameer H. Patel (University of Cincinnati Academic Health Center)H-Index: 18
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Abstract Background Differences in clinical staging and survival among pancreatic head, body, and tail cancers are not well defined. We aim to identify the prognostic relevance of primary tumor location in patients undergoing treatment for pancreatic ductal adenocarcinoma (PDAC). Materials and methods The National Cancer Database was used to identify patients with PDAC from 1998 to 2011 (n = 175,556). Patients were categorized by primary tumor site into head (67.5%, n = 118,343), body (15.5%, n ...
15 CitationsSource
#2Tara M. Mackay (UvA: University of Amsterdam)H-Index: 7
Last. Marc G. Besselink (UvA: University of Amsterdam)H-Index: 84
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AbstractBackground: The association between pancreatic ductal adenocarcinoma (PDAC) location (head, body, tail) and tumor stage, treatment and overall survival (OS) is unclear.Methods: Patients with PDAC diagnosed between 2005 and 2015 were included from the population-based Netherlands Cancer Registry. Patient, tumor and treatment characteristics were compared with the tumor locations. Multivariable logistic and Cox regression analyses were used.Results: Overall, 19,023 patients were included. ...
28 CitationsSource
#1Elke Tieftrunk (TUM: Technische Universität München)H-Index: 15
#2Ihsan Ekin Demir (TUM: Technische Universität München)H-Index: 34
Last. Güralp O. Ceyhan (TUM: Technische Universität München)H-Index: 41
view all 9 authors...
BACKGROUND: Pancreatic fistula/PF is the most frequent and feared complication after distal pancreatectomy/DP. However, the safest technique of pancreatic stump closure remains an ongoing debate. Here, we aimed to compare the safety of different pancreatic stump closure techniques for preventing PF during DP. METHODS: We performed a PRISMA-based meta-analysis of all relevant studies that compared at least two techniques of stump closure during DP with regard to PF rates/PFR. We further performed...
19 CitationsSource
#1Halit Ziya DündarH-Index: 9
#2Pinar TasarH-Index: 2
Last. Ekrem KayaH-Index: 14
view all 4 authors...
INTRODUZIONE: A differenza dei pazienti con tumore del colon-retto, l’effetto sul tasso di sopravvivenza e recidiva della deiscenza anastomotica dopo intervento chirurgico per adenocarcinoma del pancreas non e chiaro. Il presente studio ha avuto come obiettivo di determinare le conseguenze della deiscenza della pancreato-digiunostomia (PJ), in particolare sul tasso di recidiva locale e sul tempo stesso di recidiva, in pazienti sottoposti a duodenocefalopancreasectomia (DCP) per adenocarcinoma de...
3 Citations
#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 18
#2Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 23
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 26 authors...
Objective:To identify a clinical fistula risk score following distal pancreatectomy.Background:Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to
56 CitationsSource
Cited By1
#1Piera Leon (University of Montpellier)H-Index: 3
#2Fabrizio Panaro (University of Montpellier)H-Index: 21