Total pancreatectomy and pancreatic fistula: friend or foe?

Published on Aug 1, 2021in Updates in Surgery2.587
· DOI :10.1007/S13304-021-01130-3
Roberto Salvia52
Estimated H-index: 52
(University of Verona),
Gabriella Lionetto1
Estimated H-index: 1
(University of Verona)
+ 2 AuthorsGiovanni Marchegiani29
Estimated H-index: 29
(University of Verona)
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 promising tool to avoid the morbidity related to an extremely high-risk pancreatic anastomosis in selected patients. Surgical management of severe POPF is only required in few critical scenarios. In this context, even if anecdotal, CP might play a role as last resort in expert hands.
#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
#1Elisa Bannone (University of Verona)H-Index: 3
Last. Claudio BassiH-Index: 110
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OBJECTIVE To characterize early postoperative serum pancreatic amylase (spAMY) trends after pancreatic resections. SUMMARY BACKGROUND DATA A postoperative spAMY elevation is a common finding but uncertainties remain about its meaning and prognostic implications. METHODS Analysis of patients who consecutively underwent pancreatectomy from 2016 to 2019. spAMY activity was assessed from postoperative day (POD) 0 to 3. Different patterns of spAMY have been identified based on the spAMY standard rang...
3 CitationsSource
#1Giovanni Capretti (Humanitas University)H-Index: 16
#2Greta DonisiH-Index: 2
Last. Alessandro Zerbi (Humanitas University)H-Index: 57
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PURPOSE Patients with fistula risk score (FRS) ≥7 are at the highest risk of developing clinically relevant post-operative pancreatic fistula (CR-POPF). There is no agreement on the management of this subpopulation. The primary outcome of the study was the definition of the role of intraoperative completion pancreatectomy (ICP) in patients at high risk for CR-POPF, as an alternative to high-risk pancreaticoduodenectomy (PD). METHODS This is an observational study set in a single tertiary referra...
1 CitationsSource
#2Giampaolo PerriH-Index: 9
Last. Roberto SalviaH-Index: 52
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OBJECTIVE To evaluate total pancreatectomy (TP) as an alternative to pancreatoduodenectomy (PD) in patients at high-risk for postoperative pancreatic fistula (POPF). BACKGROUND Outcomes of high-risk PD (HR-PD) and TP have never been compared. METHODS All patients who underwent PD or TP between July 2017 and December 2019 were identified. HR-PD was defined according to the alternative Fistula Risk Score. Postoperative outcomes (primary endpoint), pancreatic insufficiency and quality of life after...
1 CitationsSource
#1Martin Loos (University Hospital Heidelberg)H-Index: 2
#2Arianeb MehrabiH-Index: 33
Last. Markus W. BüchlerH-Index: 173
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OBJECTIVE The aim of this study was to determine the role of gastric venous congestion (GVC) in mortality after total pancreatectomy (TP). BACKGROUND Data from a nationwide administrative database revealed that TP is associated with a 23% mortality rate in Germany. METHODS A total of 585 consecutive patients who had undergone TP (n = 514) or elective completion pancreatectomy (n = 71) between January 2015 and December 2019 were analyzed. Univariable and multivariable analyses were performed to i...
3 CitationsSource
#1T. F. Stoop (CU: University of Colorado Boulder)H-Index: 2
#2Zeeshan Ateeb (Karolinska University Hospital)H-Index: 8
Last. Marco Del Chiaro (Karolinska University Hospital)H-Index: 31
view all 7 authors...
BACKGROUND The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center. METHODS All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008-2017). High volume was defined as > 20 TPs/year. RESULTS Overall, 145 patients after TP were included, including 86 (59.3%) extended r...
7 CitationsSource
#1Jonathan GarnierH-Index: 6
#2Jacques EwaldH-Index: 11
Last. Olivier Turrini (AMU: Aix-Marseille University)H-Index: 37
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Abstract Background Emergency completion pancreatectomy (CP) after pancreatoduodenectomy (PD) is a technically demanding procedure. We report our experiences with a four-step standardized technique used at our center since 2012. Methods In the first step, the gastrojejunostomy is divided with a stapler to quickly access the pancreatic anastomosis and permit adequate exposure, especially in cases of active bleeding. Second, the bowel loops connected to the pancreatic anastomosis is divided in cas...
1 CitationsSource
#1Andreas Minh LuuH-Index: 4
Last. Orlin BelyaevH-Index: 21
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Background Total pancreatectomy (TP) eliminates the risk of postoperative pancreatic fistula (POPF) and its associated secondary complications. Hence, it may theoretically offer advantages over pancreaticoduodenectomy (PD) regarding early postoperative outcome of patients with high-risk pancreatic remnant. Methods Ninety-day mortality and morbidity of 100 TP vs. 100 PD for pancreatic head lesions were retrospectively compared. Groups were matched for pancreatic texture, pancreatic duct size, fin...
2 CitationsSource
#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...
25 CitationsSource
#1T. F. Stoop (Karolinska University Hospital)H-Index: 2
#2Zeeshan Ateeb (Karolinska University Hospital)H-Index: 8
Last. Marco Del Chiaro (Anschutz Medical Campus)H-Index: 31
view all 7 authors...
Background Total pancreatectomy (TP) is rarely performed due to concerns for endocrine and exocrine insufficiency and decreased quality of life (QoL). Renewed interest is seen in recent years, but large cohort studies remain scarce. This study was designed to evaluate endocrine and exocrine insufficiency after TP and its impact on QoL.
16 CitationsSource
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