Prevention, prediction, and mitigation of postoperative pancreatic fistula

Published on Jun 22, 2021in British Journal of Surgery5.676
· DOI :10.1093/BJS/ZNAB125
Giovanni Marchegiani29
Estimated H-index: 29
(University of Verona),
Claudio Bassi110
Estimated H-index: 110
(University of Verona)
#1Stefano Andrianello (University of Verona)H-Index: 16
#2Giovanni Marchegiani (University of Verona)H-Index: 29
Last. Claudio Bassi (University of Verona)H-Index: 110
view all 12 authors...
Importance The operative scenarios with the highest postoperative pancreatic fistula (POPF) risk represent situations in which fistula prevention and mitigation strategies have the strongest potential to affect surgical outcomes after pancreaticoduodenectomy. Evidence from studies providing risk stratification is lacking. Objective To investigate whether pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG), both with externalized transanastomotic stent, is the best reconstruction method fo...
22 CitationsSource
#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 38 authors...
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
62 CitationsSource
#1Yoshiki SendaH-Index: 13
#2Yasuhiro ShimizuH-Index: 1
Last. Tsuyoshi Sano (Aichi Medical University)H-Index: 4
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Background The postoperative pancreatic fistula (POPF) rate for duct-to-mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct-to-mucosa versus invagination pancreaticojejunostomy. Methods Patients were stratified by pancreatic texture and diameter of the main pancreatic duct and randomized to the duct-to-mucosa or invagination group. The primary endpoint was the rate of clinically relevant POPF (defined as ...
36 CitationsSource
#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
98 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 7 authors...
Abstract Introduction Clinically relevant postoperative pancreatic fistula (CR-POPF) is a morbid complication following pancreatoduodenectomy (PD). It is unclear how pancreatic surgeons perceive risk for this complication, and the implications thereof. Methods A web-based survey was distributed to members of 22 international GI surgical societies. CR-POPF risk factors were categorized as follows: (i) patient factors, (ii) pancreatic gland characteristics, (iii) intraoperative variables, (iv) per...
16 CitationsSource
#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...
1,280 CitationsSource
#1Russell S. Lewis (UPenn: University of Pennsylvania)H-Index: 10
#2Jeffrey A. Drebin (UPenn: University of Pennsylvania)H-Index: 55
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
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Introduction Survival after a resected pancreatic ductal adenocarcinoma (PDAC) appears to be improving. Yet, in spite of advancements, prognosis remains disappointing. This study analyses a contemporary experience and identifies features associated with survival.
78 CitationsSource
#1Mark P. Callery (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 66
#2Wande B. Pratt (WashU: Washington University in St. Louis)H-Index: 18
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 35
view all 5 authors...
Background Clinically relevant postoperative pancreatic fistulas (CR-POPF) are serious inherent risks of pancreatic resection. Preoperative CR-POPF risk assessment is currently inadequate and rarely disqualifies patients who need resection. The best evaluation of risk occurs intraoperatively, and should guide fistula prevention and response measures thereafter. We sought to develop a risk prediction tool for CR-POPF that features intraoperative assessment and reveals associated clinical and econ...
543 CitationsSource
#1S. L. GansH-Index: 2
Last. M. A. BoermeesterH-Index: 19
view all 6 authors...
Somatostatin analogues are used for the treatment of pancreatic fistula, with the aim of achieving fistula closure or reduction of output. Method: MEDLINE, Embase and Cochrane databases were searched systematically for relevant articles followed by hand-searching of reference lists. Data on patient recruitment, intervention and outcome were extracted and meta-analysis performed where reasonable. Results: Seven randomized clinical trials met the inclusion criteria and included a total of 297 pati...
67 CitationsSource
#1Fuyuhiko Motoi (Tohoku University)H-Index: 40
#2Shinichi Egawa (Tohoku University)H-Index: 52
Last. Michiaki Unno (Tohoku University)H-Index: 67
view all 5 authors...
Background: Postoperative pancreatic fistula (POPF) remains one of the most common causes of morbidity following pancreaticoduodenectomy (PD). This randomized trial examined whether external stent drainage of the pancreatic duct decreases the rate of POPF after PD and subsequent pancreaticojejunostomy (PJ). Methods: Consecutive patients who underwent PD with subsequent construction of a duct-to-mucosa PJ were randomized into a stented and a non-stented group. The primary outcome was the incidenc...
134 CitationsSource
Cited By1
#1Thomas Hank (University of Vienna)
#2Ulla Klaiber (University of Vienna)
Last. Oliver Strobel (University of Vienna)
view all 5 authors...
Periampullary neoplasms are a heterogeneous group of different tumor entities arising from the periampullary region, of which pancreatic ductal adenocarcinoma (PDAC) is the most common subgroup with 60-70%. As typical for pancreatic adenocarcinomas, periampullary pancreatic cancer is characterized by an aggressive growth and early systemic progression. Due to the anatomical location in close relationship to the papilla of Vater symptoms occur at an earlier stage of the disease, so that treatment...