Anastomosis Technique For Pancreatojejunostomy And Early Removal Of Drainage Tubes May Reduce Postoperative Pancreatic Fistula

Abstract Background: Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods: In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and December 2019 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n=67) and a modified group (n = 53).Results: The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (1.9% vs 22.4%, p < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group had reduced to one third of those in the conventional group (1696 vs 643 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p = 0.004).Conclusions: Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

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Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02067-4 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Hiromichi Kawaida ◽

Hiroshi Kono ◽

Hidetake Amemiya ◽

Naohiro Hosomura ◽

Mitsuaki Watanabe ◽

...

Keyword(s):

Multivariate Analysis ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Conventional Group ◽

Short Term ◽

Drainage Fluid ◽

The Third ◽

Modified Method ◽

Early Removal ◽

Soft Pancreas

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD. Methods In total, 123 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n = 67) and a modified group (n = 56). Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p value = 0.002). Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

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Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

10.21203/rs.3.rs-42715/v2 ◽

2020 ◽

Author(s):

Hiromichi Kawaida ◽

Hiroshi Kono ◽

Hidetake Amemiya ◽

Naohiro Hosomura ◽

Mitsuaki Watanabe ◽

...

Keyword(s):

Multivariate Analysis ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Conventional Group ◽

P Value ◽

Short Term ◽

Drainage Fluid ◽

The Third ◽

Modified Method ◽

Soft Pancreas

Abstract Background: Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods: In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n=67) and a modified group (n = 56).Results: The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p-value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p-value = 0.002).Conclusions: Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

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Original Scientific Report Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

10.21203/rs.3.rs-31073/v1 ◽

2020 ◽

Author(s):

Hiromichi Kawaida ◽

Hiroshi Kono ◽

Hidetake Amemiya ◽

Naohiro Hosomura ◽

Mitsuaki Watanabe ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Conventional Group ◽

Short Term ◽

Drainage Fluid ◽

The Third ◽

Early Removal ◽

Soft Pancreas ◽

Scientific Report

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and December 2019 were analyzed. We divided these patients into two groups: a conventional group (n = 67) and a modified group (n = 53).Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (1.9% vs 22.4%, p < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group had reduced to one third of those in the conventional group (1696 vs 643 U/L).Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

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The Individualized Selection of Pancreaticoenteric Anastomosis in Pancreaticoduodenectomy

10.21203/rs.3.rs-30580/v1 ◽

2020 ◽

Author(s):

Ke-Min Jin ◽

Wei Liu ◽

Kun Wang ◽

Quan Bao ◽

Hong-Wei Wang ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Operation Time ◽

Postoperative Management ◽

Postoperative Pancreatic Fistula ◽

Drainage Fluid ◽

Soft Pancreas ◽

Pancreatic Texture ◽

The Impact

Abstract Background: The mortality following pancreaticoduodenectomy has markedly decreased but remains an important challenge for the complexity of operation and technical skills involved. The present study aimed to clarify the impact of individualized pancreaticoenteric anastomosis and management to postoperative pancreatic fistula.Methods: Data from 529 consecutive pancreaticoduodenectomies were retrospectively analysed from the Hepatobiliary and Pancreatic Surgery Unit I, Peking Cancer Hospital. The pancreaticoenteric anastomosis was determined based on the pancreatic texture and diameter of the main pancreatic duct. The amylase value of the drainage fluid was dynamically monitored postoperatively on days 3, 5 and 7. A low speed intermittent irrigation was performed in selected patients. Intraoperative and postoperative results were collected and compared between the pancreaticogastrostomy (PG) group and pancreaticojejunostomy (PJ) group.Results: From 2010 to 2019, 529 consecutive patients underwent pancreaticoduodenectomy. Pancreaticogastrostomy was performed in 364 patients; pancreaticojejunostomy was performed in 150 patients respectively. The clinically relevant pancreatic fistula (CR-POPF) was 9.8% and mortality was zero. The soft pancreas, diameter of main pancreatic duct≤3mm, BMI≥25, operation time>330min and pancreaticogastrostomy was correlated with postoperative pancreatic fistula significantly. The CR-POPF of PJ was significantly higher than that of PG in soft pancreas patients; the operation time of PJ was shorter than that of PG significantly in hard pancreas patients. Intraoperative blood loss and operation time of PG was less than that of PJ significantly in normal pancreatic duct patients (p<0.05).Conclusions: Individualized pancreaticoenteric anastomosis should be determined based on the pancreatic texture and pancreatic duct diameter. The appropriate anastomosis and postoperative management could prevent mortality.

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Efficacy of Enteral Nutrition by Double Elementary Diet Tube after Pylorus-Preserving Pancreatoduodenectomy

The American Surgeon ◽

10.1177/000313481908500425 ◽

2019 ◽

Vol 85 (4) ◽

pp. 359-364 ◽

Cited By ~ 1

Author(s):

Toru Sano ◽

Naokazu Chiba ◽

Takahiro Gunji ◽

Yosuke Ozawa ◽

Kosuke Hikita ◽

...

Keyword(s):

Enteral Nutrition ◽

Pancreatic Fistula ◽

Nutritional Support ◽

Lumbar Vertebra ◽

Postoperative Pancreatic Fistula ◽

Muscle Area ◽

The Third ◽

Soft Pancreas ◽

Parental Nutrition ◽

Skeletal Muscle Area

Nutritional support after pylorus-preserving pancreaticoduodenectomy (PpPD) is still controversial. This study aimed to evaluate the efficacy of enteral nutrition (EN) via the double elementary diet (W-ED) tube after PpPD. One hundred two patients who received EN by the W-ED tube were compared with 52 patients who received total parental nutrition (TPN) previously. Clinicopatho-logical and postoperative features were analyzed among the two groups. Patients with EN by the W-ED tube after PpPD had a lower incidence of postoperative pancreatic fistula than those with TPN. The total protein and albumin levels on discharge in the EN group were significantly higher than those in the TPN group. In the case without complication, decreasing rate of the third lumbar vertebra skeletal muscle area was significantly lower in the EN group. In the cases of soft pancreas, drainage volume by the W-ED tube until four postoperative day was significantly larger in the case without postoperative pancreatic fistula. The W-ED tube offers the advantages of reducing gastrointestinal pressure and enabling reduction of complications after PpPD surgery.

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Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience

10.1101/2020.05.04.20090241 ◽

2020 ◽

Author(s):

Gao Qing Wang ◽

Dipesh Kumar Yadav ◽

Wei Jiang ◽

Yong Fei Hua ◽

Cai De Lu

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Main Pancreatic Duct ◽

Surgical Complication ◽

Univariate Analysis ◽

Postoperative Pancreatic Fistula ◽

Soft Pancreas

AbstractClinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevant guidelines and regulations. The univariate and multivariate analysis was performed was performed to test an independent risk factors for pancreatic fistula. P<0.05 was considered statistically significant. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication 19.0%. The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct are more likely to develop pancreatic fistula. However, on multivariate analysis the soft texture of the pancreas (OR= 2.381, P= 0.001) and the ligation of main pancreatic duct (OR= 0.388, P= 0.002) were only an independent influencing factor for CR-POPF. As a conclusion, pancreatic fistula was the most common surgical complication after DP, and the texture of pancreas and ligation of main pancreatic duct can influence an incidence of CR-POPF.

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Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽

10.1186/s12893-020-00968-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Runwen Liu ◽

Yunqiang Cai ◽

He Cai ◽

Yajia Lan ◽

Lingwei Meng ◽

...

Keyword(s):

Prediction Model ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Laparoscopic Pancreaticoduodenectomy ◽

C Reactive Protein ◽

Dynamic Prediction ◽

Albumin Ratio ◽

Drainage Fluid ◽

Reactive Protein ◽

Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

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