Is Ultrasound Elastography Useful in Predicting Clinically Relevant Pancreatic Fistula After Pancreatic Resection?

“Soft pancreas” has often been reported as a predictive factor for postoperative pancreatic fistula (POPF) after pancreatectomy. However, pancreatic stiffness is judged subjectively by surgeons, without objective criteria. In the present study, pancreatic stiffness was quantified using intraoperative ultrasound elastography, and its relevance to POPF and histopathology was investigated. Forty-one patients (pancreatoduodenectomy, 30; distal pancreatectomy, 11) who underwent intraoperative elastography during pancreatectomy were included. The elastic ratio was determined at the pancreatic resection site (just above the portal vein) and at the remnant pancreas (head or tail). Correlations between the incidence of POPF and patient characteristics, operative variables, and the elastic ratio were examined. In addition, the relationship between the elastic ratio and the percentage of the exocrine gland at the resection stump was investigated. For pancreatoduodenectomy patients, main pancreatic duct diameter < 3.2 mm and elastic ratio < 2.09 were significant risk factors for POPF. In addition, the elastic ratio, but not main pancreatic duct diameter, was significantly associated with the percentage of exocrine gland area at the pancreatic resection stump. Pancreatic stiffness can be quantified using intraoperative elastography. Elastography can be used to diagnose “soft pancreas” and may thus be useful in predicting the occurrence of POPF.

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Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection

The American Surgeon ◽

10.1177/000313481808400138 ◽

2018 ◽

Vol 84 (1) ◽

pp. 149-153 ◽

Cited By ~ 1

Author(s):

Takao Ohtsuka ◽

Yasuhisa Mori ◽

Takaaki Fujimoto ◽

Yoshihiro Miyasaka ◽

Kohei Nakata ◽

...

Keyword(s):

High Risk ◽

Pancreatic Fistula ◽

Pancreatic Resection ◽

Medical Records ◽

Operation Time ◽

Postoperative Pancreatic Fistula ◽

Postoperative Hospital Stay ◽

High Risk Patients ◽

Risk Patients ◽

Related Mortality

The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with ( n = 10) and without ( n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer ( P < 0.01) and blood loss significantly greater ( P < 0.01) in patients with pancreatojejunostomy. Overall complications were more frequent ( P = 0.02) and postoperative hospital stay was significantly longer ( P = 0.02) in patients with pancreatojejunostomy. However, other assessed factors including the prevalence of postoperative PF did not differ between groups. In conclusion, prophylactic pancreatojejunostomy is feasible, and its efficacy in preventing PF after enucleation or limited pancreatic resection in high-risk patients will require further study.

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Early Post-Operative Pancreatitis and Systemic Inflammatory Response Assessed by Serum Lipase and IL-6 Predict Pancreatic Fistula

World Journal of Surgery ◽

10.1007/s00268-020-05768-9 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4236-4244

Author(s):

S. Gasteiger ◽

F. Primavesi ◽

G. Göbel ◽

E. Braunwarth ◽

B. Cardini ◽

...

Keyword(s):

Inflammatory Response ◽

Pancreatic Fistula ◽

Pancreatic Resection ◽

Roc Analysis ◽

Youden Index ◽

Clinical Trial Registration ◽

Serum Lipase ◽

Mortality And Morbidity ◽

Prospective Pilot Study ◽

Early Predictor

Abstract Background Post-operative pancreatic fistula (POPF) remains a critical complication after pancreatic resection. This prospective pilot study evaluates perioperative markers of pancreatitis and systemic inflammation to predict clinically relevant grade B/C-POPF (CR-POPF). Methods All patients undergoing pancreatic resection from December 2017 to April 2019 were prospectively enrolled. Surgical procedures and outcomes were correlated with perioperative blood markers. ROC analysis was performed to assess their predictive value for CR-POPF. Cut-offs were calculated with the Youden index. Results In total, 70 patients were analysed (43 pancreatoduodenectomies and 27 distal pancreatectomies). In-hospital/90-d mortality and morbidity were 5.7/7.1% (n = 4/n = 5) and 75.7% (n = 53). Major complications (Clavien–Dindo ≥ 3a) occurred in 28 (40.0%) patients, CR-POPF in 20 (28.6%) patients. Serum lipase (cut-off > 51U/L) and IL-6 (> 56.5 ng/l) on POD3 were significant predictors for CR-POPF (AUC = 0.799, 95%-CI 0.686–0.912 and AUC = 0.784, 95%-CI 0.668–0.900; combined AUC = 0.858, 95%-CI 0.758–0.958; all p < 0.001). Patients with both or one factor(s) above cut-off more frequently developed CR-POPF than cases without (100 vs. 50% vs. 7.5%, p < 0.001). This also applied for overall and severe complications (p = 0.013 and p = 0.009). Conclusions Post-operative pancreatitis and inflammatory response are major determinants for development of POPF. A combination of serum lipase and IL-6 on POD3 is a highly significant early predictor of CR-POPF and overall complications, potentially guiding patient management. Clinical trial registration The study protocol was registered at clinicaltrials.gov (NCT04294797)

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Preoperative Ultrasound Elastography (SWE) predicts increased risk of Pancreatic Fistula (POPF) after pancreaticoduodenectomy

10.1055/s-0041-1733601 ◽

2021 ◽

Author(s):

V von Ehrlich-Treuenstätt ◽

M Ilmer ◽

D Clevert ◽

H Niess ◽

J D’Haese ◽

...

Keyword(s):

Pancreatic Fistula ◽

Ultrasound Elastography ◽

Preoperative Ultrasound ◽

Increased Risk

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Postoperative pancreatic fistula after pancreatic resection

Bratislava Medical Journal ◽

10.4149/bll_2020_090 ◽

2020 ◽

Vol 121 (08) ◽

pp. 541-546

Author(s):

M. Sabol ◽

R. Donat ◽

D. Dyttert ◽

V. Reken ◽

D. Sintal ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Postoperative Pancreatic Fistula

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Pancreatic fistulae following pancreatic resection. Analysis of causes and prevention methods

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(4)-11 ◽

2018 ◽

Vol 22 (4) ◽

pp. 640-646

Author(s):

K.G. Valikhnovska

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Pancreatic Resection ◽

Pancreatic Head ◽

Preoperative Period ◽

External Drainage ◽

Distal Pancreatic Resection ◽

Glycemic Level ◽

Prevention Methods

The causes of pancreatic fistula were analyzed in 503 patients aged from 22 to 81who underwent pancreaticoduodenectomy for pancreatic and periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve the outcomes of pancreatic resection based on a retrospective analysis of the risk factors of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. The influence of factors on the risk of pancreatic fistula was investigated by Pearson method (χ2). The factors contributing to the occurrence of pancreatic fistulae included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head, χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=12.75,1, p<0.001), technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage, χ2=44.01,1, p<0.0001), resection of venous vessels following distal pancreatic resection (χ2=8.350,1, p=0.0039, p<0.01), glycemic level in the preoperative period (P=0.0344,U=15061), the presence of concomitant diseases in patients (χ2=15.62,1, p=0.0001, p<0.001). Preoperative glycemic level and the presence of concomitant diseases in patients are factors that can be influenced to prevent the onset of pancreatic fistula in the postoperative period in patients who are scheduled for pancreatic resection. Prevention of this complication involves the correction of glycemic level and treatment of concomitant pathology in patients in the preoperative period.

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Mo2023 STEROID EFFECT ON POSTOPERATIVE PANCREATIC FISTULA AFTER PANCREATIC RESECTION

Gastroenterology ◽

10.1016/s0016-5085(20)34637-0 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1582

Author(s):

Minsang Kim ◽

Michael A. Mederos ◽

Harsh Patel ◽

Vileena Koneru ◽

Daniela Markovic ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Postoperative Pancreatic Fistula

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Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections

The American Surgeon ◽

10.1177/000313480907501020 ◽

2009 ◽

Vol 75 (10) ◽

pp. 954-957 ◽

Cited By ~ 12

Author(s):

Eduardo A. Guzman ◽

Rebecca A Nelson ◽

Joseph Kim ◽

Alessio Pigazzi ◽

Vijay Trisal ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Staple Line ◽

Parenchymal Transection ◽

Staple Line Reinforcement ◽

Distal Pancreatic Resection ◽

Pancreatic Resections ◽

Clinicopathologic Factors ◽

Pancreatic Fistulas ◽

Definition Of

Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

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