Pancreatic Inflammation and Proenzyme Activation Are Associated With Clinically Relevant Postoperative Pancreatic Fistulas After Pancreas Resection

The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within 3 postoperative days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among the patients with drain fluid amylase < 5000 IU on the first postoperative day, the early removal group had fewer complications and shorter hospital stays than the late removal group (30.9% vs. 54.5%, p < 0.001; 9.8 vs. 12.5 days, p = 0.030, respectively). The incidences of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase CR-POPFs (p = 0.163). Although early drain removal has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

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Multidisciplinary Management of Postoperative Pancreatic Fistula

Digestive Disease Interventions ◽

10.1055/s-0040-1721785 ◽

2021 ◽

Author(s):

Alexa Glencer ◽

Kim Kirkwood ◽

Adam Schwertner ◽

Cody Keller ◽

Mustafa Arain ◽

...

Keyword(s):

Interventional Radiology ◽

Pancreatic Fistula ◽

Multidisciplinary Approach ◽

Postoperative Morbidity ◽

Postoperative Pancreatic Fistula ◽

Significant Source ◽

Successful Outcome ◽

Multidisciplinary Management ◽

Economic Strain ◽

Pancreatic Fistulas

AbstractPostoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary approach by a team whose skills include abdominal imaging, specialized surgery, advanced endoscopy, and interventional radiology. Intensive resources and time are often required, which impacts both patients and their caregivers. While treatment(s) continue to improve, a primary goal of research efforts in this area is the prevention of this significant source of postoperative morbidity, mortality, and economic strain.

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Pancreaticogastrostomy after Pancreaticoduodenectomy Using Twin Square Wrapping with Duct-to-Mucosa Anastomosis

European Surgical Research ◽

10.1159/000433425 ◽

2015 ◽

Vol 55 (1-2) ◽

pp. 109-118 ◽

Cited By ~ 6

Author(s):

Kosei Maemura ◽

Yuko Mataki ◽

Hiroshi Kurahara ◽

Shinichiro Mori ◽

Naotomo Higo ◽

...

Keyword(s):

Operating Time ◽

Conventional Group ◽

C Reactive Protein ◽

Pancreatic Anastomosis ◽

Pancreatic Stump ◽

Reactive Protein ◽

Significant Difference ◽

Pancreatic Fistulas ◽

Hospital Stays ◽

Blood Loss Volume

Background/Purpose: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreatic stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis [twin square wrapping (TSW) method]. Methods: Fifty-three patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and chronologically divided into a conventional group (n = 32) and a TSW group (n = 21). The perioperative factors and the postoperative outcomes were retrospectively analyzed. Results: The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume in the TSW group were lower than in the conventional group, but without a statistically significant difference. The TSW group had a significantly lower postoperative white blood cell count and C-reactive protein level, with a reduced intra-abdominal fluid accumulation as assessed by computed tomography on postoperative day 7, had a lower incidence of postoperative complications and pancreatic fistulas, and achieved a shorter duration of drain placement and shorter postoperative hospital stays as compared to the conventional group. Conclusions: The TSW technique should be considered for reducing pancreatic fistulas by diminishing the postoperative inflammatory response and improving patient outcomes without increasing the operating time.

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Risk Scores and Prognostic Models in Surgery: Pancreas Resection as a Paradigm

Current Problems in Surgery ◽

10.1067/j.cpsurg.2012.08.002 ◽

2012 ◽

Vol 49 (12) ◽

pp. 731-795 ◽

Cited By ~ 7

Author(s):

Russell S. Lewis ◽

Charles M. Vollmer

Keyword(s):

Prognostic Models ◽

Risk Scores ◽

Pancreas Resection

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Intraductal papillary mucinous neoplasm of the pancreas; resection and cancer prevention

The American Journal of Surgery ◽

10.1016/j.amjsurg.2007.05.020 ◽

2007 ◽

Vol 194 (4) ◽

pp. S95-S99 ◽

Cited By ~ 13

Author(s):

Toshihide Imaizumi ◽

Takashi Hatori ◽

Nobuhiko Harada ◽

Akira Fukuda ◽

Ken Takasaki ◽

...

Keyword(s):

Cancer Prevention ◽

Intraductal Papillary Mucinous Neoplasm ◽

Mucinous Neoplasm ◽

Pancreas Resection

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Results of complex treatment of patients with operable pancreatic head cancer using preoperative intra-arterial chemotherapy in combination with radiation therapy in multifractionation mode

Medical alphabet ◽

10.33667/2078-5631-2021-37-32-36 ◽

2022 ◽

pp. 32-36

Author(s):

D. A. Sklyar ◽

A. V. Pavlovsky ◽

A. A. Polikarpov ◽

S. A. Popov ◽

V. E. Moiseenko ◽

...

Keyword(s):

Radiation Therapy ◽

Pancreatic Head ◽

Main Group ◽

Arterial Infusion ◽

Conformal Radiation Therapy ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Postoperative Pancreatitis ◽

Pancreatic Fistulas ◽

And Control

The aim of this study was to assess the safety and efficacy of treating patients with operable pancreatic cancer after preoperative intra-arterial infusion of chemotherapy combined with conformal radiation therapy in a multi-fractionation mode. Patients (n = 40) were randomized into two groups: the main one – intra-arterial infusion of chemotherapy + radiation therapy + surgery (n = 20), and control – intra-arterial infusion of chemotherapy + surgery (n = 20). Neoadjuvant therapy consisted of intra-arterial infusion of chemotherapy (chemoembolization of a pancreatic head tumor with oxaliplatin 85 mg/m2) followed by intra-arterial chemo infusion with gemcitabine 1000 mg/m2. In the main group, radiation therapy was also carried out in two fractions per day, 2 Gy with an interval of 4–6 hours, 5 days a week, up to a total dose of 50 Gy. In the main group, the lower incidence of postoperative pancreatitis and the pancreatic fistulas were statistically confirmed, the incidence of grade 2 therapeutic pathomorphisis increased, as well as the median life expectancy.

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Protective or Risk Factors for Postoperative Pancreatic Fistulas in Malignant Pathology

Life ◽

10.3390/life11111216 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1216

Author(s):

Vasilescu Alin Mihai ◽

Andriesi Rusu Delia Florina ◽

Bradea Costel ◽

Vlad Nutu ◽

Ursulescu-Lupascu Corina ◽

...

Keyword(s):

Acute Pancreatitis ◽

Protective Factor ◽

Malignant Tumors ◽

Fibrous Tissue ◽

Ductal Adenocarcinoma ◽

Main Diagnosis ◽

Entire Study ◽

Periampullary Adenocarcinoma ◽

Pancreatic Resections ◽

Pancreatic Fistulas

Introduction: Malignant tumors are associated with a low incidence of postoperative pancreatic fistulas. The presence of peritumoral fibrosis is considered the protective factor for the development of postoperative pancreatic fistulas after pancreatic resections for pancreatic ductal adenocarcinomas. Methods: We analyzed a series of 109 consecutive patients with pancreatic resections for malignant pathology: pancreatic ductal adenocarcinomas and periampullary adenocarcinomas. The incidence of postoperative pancreatic fistulas has been reported in tumor histological type, in the presence of peritumoral fibrosis, and in the association between adenocarcinomas and areas of acute pancreatitis. The data obtained were processed with the statistical analysis program SPSS, and statistically significant p were considered at a value <0.05. Results: For the entire study group, the incidence of postoperative pancreatic fistulas was 11.01%. The lowest incidence was observed in the group of patients with pancreatic ductal adenocarcinomas (4.06% vs. 25.72% in the group with periampullary adenocarcinoma), with a p = 0.002. The presence of peritumoral fibrous tissue was observed in 49.31% of cases without pancreatic fistulas, and in 54.54% of cases that developed this postoperative complication (p = 0.5). Also, the peritumoral fibrous tissue had a uniform distribution depending on the main diagnosis (56.14% in pancreatic ductal adenocarcinoma group vs. 37.04% in periampullary adenocarcinoma group, with a p = 0.08). In the group of patients who associated areas of acute pancreatitis on the resections, the incidence of postoperative pancreatic fistulas was 7.8 times higher (30% vs. 3.8%, p = 0.026). Conclusions: Peritumoral fibrous tissue was not a factor involved in the developing of postoperative pancreatic fistulas. The association of adenocarciomas with areas of acute pancreatitis has led to a significant increase in postoperative pancreatic fistulas, which is a significant and independent risk factor.

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Short-and long-term results of distal pancreatectomy

Perm Medical Journal ◽

10.17816/pmj3626-13 ◽

2019 ◽

Vol 36 (2) ◽

pp. 6-13

Author(s):

V. N. Barykov ◽

A. G. Istomin ◽

R. R. Abdrashitov ◽

A. S. Ryzhikh

Keyword(s):

Distal Pancreatectomy ◽

Long Term Results ◽

Benign Tumors ◽

Pancreatic Stump ◽

Pancreatogenic Diabetes ◽

Pancreatic Fistulas ◽

Short And Long Term ◽

Wirsung Duct ◽

One Year

Aim. To assess the results of distal pancreatectomy for malignant and benign tumors and chronic pancreatitis complications. Materials and methods. Forty-seven patients, who underwent distal pancreatectomy, were under observation during the period from 01.01.2008 to 28.02.2019. Results. The long-term results of surgical treatment demonstrated the following complications: pancreatic fistulas – 15 % of observations, pancreatogenic diabetes mellitus – 12.7 %, subphrenic abscesses – 10 %. In the long-term period after the surgery – from 10 years and not less than one year – 30 patients were followed up, constituting 63.8 % of the total number. Conclusions. To prevent complications in the form of pancreatic fistula with pathological Wirsung duct dilatation more than 4–5 mm in diameter, it is necessary to form anastomosis between the pancreatic stump and the small bowel.

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