Predictors and Outcomes of Pancreatic Fistula Following Pancreaticoduodenectomy: a Dual Center Experience
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ORIGINAL ARTICLE
Predictors and Outcomes of Pancreatic Fistula Following Pancreaticoduodenectomy: a Dual Center Experience Suneed Kumar 1 & Abhijit Chandra 2 & Shibumon M. Madhavan 1 & Dinesh Kumar 1 & Smita Chauhan 1 & Anshuman Pandey 1 & Shakeel Masood 1 Received: 26 April 2020 / Accepted: 19 August 2020 # Indian Association of Surgical Oncology 2020
Abstract Fistula following leaked pancreatico-enteric anastomosis is a common, potentially lethal complication of pancreaticoduodenectomy (PD). Early assessment and prediction of its occurrence can improve postoperative outcomes. Various perioperative factors were analyzed for its contribution to clinically relevant postoperative pancreatic fistula (crPOPF). Also, the difference in clinical outcomes of patients with and without fistula was studied. Sixty-seven patients undergoing PD for malignancies were analyzed during 3-year period in a dual-institutional study. Various preoperative, intraoperative, and postoperative factors were assessed. The incidence and severity of POPF and its association with the development of other post-PD complications were observed. Patients with and without POPF were divided into groups and compared with univariate and multivariate analyses, to identify significant contributing factors. Clinically relevant POPF was present in 20.9% cases. crPOPF contributed to delayed gastric emptying, albeit insignificant (p = 0.403), but was significantly associated with increased incidence of post-pancreatectomy hemorrhagic (p = 0.005) and infectious complications (p = 0.013). Soft pancreas (p = 0.024), intraoperative blood loss (p = 0.045), blood transfusion (p = 0.024), and fistula risk score (p = 0.001) were significant predictors of crPOPF. First postoperative day (POD1) drain fluid amylase (DFA) values at cut-off of 1336 U/L (AUC = 0.871; p < 0.001) significantly predicted crPOPF with good sensitivity and specificity. POD1 DFA was only factor significant on multivariate analysis (p = 0.014). There was no significant difference in overall survival between groups. crPOPF results in significant post-pancreatectomy hemorrhagic and septic complications, along with increased mortality. It can be accurately predicted by several preoperative and intraoperative factors. POD1 DFA can independently predict crPOPF development. Keywords Whipple’s procedure . Complications . Clinically relevant POPF . Periampullary cancer
Introduction Pancreaticoduodenectomy (PD) is the time-tested surgical treatment of choice for periampullary cancers. Ever since the first description in the early twentieth century, the operative mortality rate has significantly fallen from 18% in the 1970s [1] to less than 3% today in high-volume centers [2]. The postoperative morbidity, however, has reached a plateau at
* Shakeel Masood [email protected] 1
Department of Surgical Gastroenterology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow, Uttar Pradesh 226010, India
2
Department of Surgical Gastroenterology, King George Medical U
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