Preoperative and intraoperative risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy – systematic review and meta-analysis

2021 ◽  
Vol 93 (6) ◽  
pp. 1-10
Author(s):  
Kajetan Kiełbowski ◽  
Estera Bakinowska ◽  
Rafał Uciński
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Significant Risk ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Anastomosis ◽  
Pancreatic Fat ◽  
Number Of Patients ◽  
Potential Risk Factors ◽  
Mean Differences

Introduction: Postoperative pancreatic fistula (POPF) is a potentially life-threatening complication after pancreaticoduodenectomy (PD). It is observed when the amylase activity in the drain fluid exceeds three times the normal upper value. Grades B and C of POPF are considered as clinically relevant. Fistula might originate due to failure of healing of a pancreatic anastomosis or from raw pancreatic surface. Materials and methods: 18 retrospective and prospective studies published between 2015 and 2020 were included in this meta-analysis. Total number of patients was 5836. To investigate potential risk factors associated with the occurrence of POPF, odds ratios (OR) with 95% confidence intervals (CI) were calculated. To compare discontinuous data, mean differences (MD) were calculated. Results: 13 factors were divided into preoperative and intraoperative groups. Male sex, higher BMI, soft pancreatic texture and small pancreatic duct were considered as significant risk factors while vascular resection lowered the risk of development pancreatic fistula. Discussion: It is considered that the development of POPF is associated with intrapancreatic fat. More severe infiltration with fat tissue is responsible for soft texture of the gland, while higher BMI is one of the risk factors of increased pancreatic fat. On the contrary, diabetes is associated with fibrotic pancreas which could lower the risk of developing POPF.

scholarly journals Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

2020 ◽  
Vol 405 (8) ◽  
pp. 1219-1231
Author(s):  
Sergio Pedrazzoli ◽  
Alessandra R. Brazzale
Keyword(s):  
Pancreatic Fistula ◽  
English Literature ◽  
Meta Analysis ◽  
Pool Analysis ◽  
Incidence Rates ◽  
Postoperative Pancreatic Fistula ◽  
Standard Management ◽  
Drain Removal ◽  
Number Of Patients ◽  
Related Mortality

Abstract Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.

scholarly journals Intraoperative pancreatic injury gives rise to severe postoperative pancreatic fistula: Results of a review of unedited videos of the laparoscopic surgical procedures

2018 ◽  
Author(s):  
Yuya Sato ◽  
Kazuyuki Kojima ◽  
Mikito Inokuchi ◽  
Keiji Kato ◽  
Hirofumi Sugita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Surgical Procedures ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Pancreatic Injury ◽  
Postoperative Pancreatic Fistula ◽  
Video Recordings ◽  
Significant Difference ◽  
Laparoscopic Surgical Procedures

Objective To examine risk factors for and causes of severe postoperative pancreatic fistula (sPOPF) after laparoscopic gastrectomy (LG) Summary of Background Data There are few reports on POPF after LG. Methods Between February 2012 and March 2014, we examined 86 patients who underwent LG comparing them with 33 patients who underwent open gastrectomy (OG) for gastric cancer. Risk factors for severe POPF (sPOPF) of Clavien-Dindo grade IIIa or higher were examined. To investigate causes of sPOPF, we reviewed unedited video recordings of laparoscopic surgical procedures. Results sPOPF occurred to 3 patients (3.5%) after LG and 1 patient (3.0%) after OG, indicating no significant difference (p=0.901). Univariate analysis showed no significant risk factors for sPOPF after LG. By reviewing video recordings, all 3 patients with sPOPF after LG had direct pancreatic injury by ultrasonically activated device (USAD) during peripancreatic lymphadenectomy. In 2 of them, pancreas was injured while the contour of pancreas was obscured by bleeding. Durations of drain placement and postoperative hospitalization were longer for patients with sPOPF than for those without POPF or grades I and II POPF (p = 0.003, 0.018; respectively). Conclusions No risk factors for sPOPF after LG could be identified. USAD-induced direct pancreatic injury resulted in sPOPF, which significantly complicated the postoperative clinical course. Direct pancreatic injury can occur whether patient has previously reported risk factors (i.e. male, high BMI, distal pancreatectomy) or not. To prevent pancreatic injury, surgeons should manage hemostasis and keep good surgical field to recognize the contour of pancreas accurately.

Article Commentary: Risk Factors of Pancreatic Fistula after Pancreaticoduodenectomy: A Collective Review

2011 ◽  
Vol 77 (3) ◽  
pp. 257-269 ◽  
Author(s):  
Giovanni Ramacciato ◽  
Paolo Mercantini ◽  
Niccolò Petrucciani ◽  
Giuseppe R. Nigri ◽  
Andrea Kazemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Technique ◽  
Length Of Stay ◽  
Pancreatic Fistula ◽  
Perioperative Management ◽  
Meta Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Diagnosis And Treatment ◽  
Current Evidence ◽  
The Ideal

Postoperative pancreatic fistula (POPF) is the most frequent complication after pancreaticoduodenectomy, results in increased morbidity and mortality, and adversely affects length of stay and costs. Reported rates of postoperative pancreatic fistula vary from 0 per cent up to more than 30 per cent. Plenty of randomized trails and meta-analysis were published to analyze the ideal procedure, technique of anastomosis, and perioperative management of patients undergoing pancreaticoduodenectomy; however, results are often discordant and clear evidence on the ideal management and surgical technique to reduce POPF rate is not yet provided. This collective review examined the current evidence about risk factors contributing to postoperative pancreatic fistula and delineates methods of diagnosis and treatment of this universally dreaded complication.

scholarly journals Postoperative pancreatic fistulas after pancreaticoduodenectomy using pair-watch suturing and duct-to-mucosa pancreaticojejunostomy anastomosis techniques 

2021 ◽  
Author(s):  
Nattapon Passawart ◽  
Warit Rungsrithananon ◽  
Warakon Jaseanchiun
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Cohort Analysis ◽  
Significant Risk ◽  
International Study ◽  
Tumor Site ◽  
Pancreatic Anastomosis ◽  
Retrospective Cohort Analysis ◽  
Significant Difference ◽  
Pancreatic Fistulas

Abstract Background: Morbidity and mortality after pancreaticoduodenectomy (PD) have been associated with postoperative pancreatic fistula (POPF). Pancreatic anastomosis is challenging for most surgeons, and there is no universal or standardized technique. This study compared the incidence of POPF between the pair-watch suturing technique (PWST) and duct-to-mucosa pancreaticojejunostomy (PJ) anastomosis technique. Methods: This retrospective cohort analysis included 71 patients who underwent a PD between January 2009 and October 2018. The incidence and risk factors of complications after PWST and duct-to-mucosa PJ anastomoses were compared. Results: There was no significant difference in the incidence of POPF between the PWST (n = 7; 30.4%) and duct-to-mucosa PJ (n = 9; 18.7%) groups. The tumor site (p = 0.001) and pancreas density on computed tomography without contrast (p = 0.002) were significantly different between the groups. Age ≥ 60 years (odds ratio (OR): 11.07; 95% confidence interval (CI): 1.14–107.36; p = 0.038) and pancreatic body mass/duct size (B/W) ratio (OR: 1.41; 95% CI: 1.04–1.91; p = 0.029) were identified as significant risk factors for POPF. International Study Group for Pancreatic Fistula grade B POPF, wound infections, and pneumonia occurred more frequently in patients who underwent a duct-to-mucosa PJ anastomosis. However, the postoperative complications were not significantly different between the groups. Conclusions: The incidence of clinically relevant POPF was similar between patients who underwent the PWST and those who underwent a duct-to-mucosa PJ anastomosis. However, a preoperative risk factor assessment for the evaluation of tumor site, patient age, and B/W ratio could help determine which surgical technique should be used in individual patients.

scholarly journals Risk factors and population attributable risk percent for lactation mastitis in Chinese women: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Baoyong Lai ◽  
Bo-Wen Yu ◽  
Ai-Jing Chu ◽  
Shi-Bing Liang ◽  
Li-Yan Jia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chinese Women ◽  
Meta Analysis ◽  
Population Attributable Risk ◽  
Significant Risk ◽  
Medical Personnel ◽  
Attributable Risk ◽  
Sleeping Position ◽  
Modifiable Factors ◽  
Potential Risk Factors

Abstract Background: Lactation mastitis (LM) is one of the most common breast disorders experienced by postpartum women, affecting approximately 3% to 20% breastfeeding mothers. Although a few researches have studied the risk factors related to LM, there are still some inconsistent problems on this topic and nationally representative evidence is scarce. This study was aimed to determine the well-accepted risk factors for LM in Chinese women. Methods: Six electronic literature databases were searched from their inception to June 1st, 2020. We used RevMan5.3 and Stata14.0 for data analysis. The strength of the association was summarized using odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors. The fail-safe number (Nfs) was used to estimate publication bias and robustness of the current results. Results: Twelve studies involving 6539 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper breastfeeding posture (OR 2.47, 95%CI 2.09-2.92; PAR 26.51%), improper milking method (OR 6.79, 95%CI 3.45-13.34; PAR 59.14%), repeated milk stasis (OR 6.08, 95%CI 3.75-9.88; PAR 37.42%), little or no cleaning of nipples (OR 2.38, 95%CI 1.88-3.03; PAR 31.28%), abnormal nipple or crater nipple (OR 2.94, 95%CI 1.76-4.91; PAR 33.99%), primipara (OR 1.91, 95%CI 1.26-2.90; PAR 39.06%), history of breast trauma (OR 3.57, 95%CI 2.86-4.46; PAR 13.36%), experience of cesarean section (OR 1.77, 95%CI 1.32-2.38; PAR 28.34%), low educational level (OR 1.85, 95%CI 1.04-3.28, PAR 23.67%), breast massage experience of non-medical personnel (OR 1.90, 95%CI 1.36-2.65, PAR 20.89%), postpartum within 6 months (OR 5.11, 95%CI 2.66-9.82; PAR 65.93%), prone sleeping position (OR 2.53, 95%CI1.51-4.22; PAR 22.72%) and postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92-5.65; PAR 56.95%). There seemed to be good robustness of the pooled results for most of the included risk factors.Conclusion: This study found several important risk factors of LM in Chinese women. In particular, the incidence of LM can be reduced by controlling several modifiable factors such as breastfeeding posture, milking method, milk stasis situation and nipple cleaning condition, etc.

scholarly journals Risk factors of postoperative delirium in the knee and hip replacement patients: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiao Rong ◽  
Zi-chuan Ding ◽  
Hao-da Yu ◽  
Shun-Yu Yao ◽  
Zong-Ke Zhou
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Hip Replacement ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Significant Risk ◽  
Replacement Surgery ◽  
Obstructive Sleep ◽  
Potential Risk Factors ◽  
Newcastle Ottawa Scale

Abstract Background The risk factors of postoperative delirium (POD), a serious while preventable complication, developed by patients undergoing knee and replacement surgery are still under investigation. In this systematic review and meta-analysis, we identified risk factors associated with POD in knee and hip replacement. Methods PubMed, Ovid MEDLINE, and Ovid EMBASE were used to identify original researches. The studies evaluating the risk factors of POD after knee and hip replacement were reviewed, and the qualities of the included studies were assessed with Newcastle–Ottawa Scale. Data were extracted, pooled, and a meta-analysis was completed Result Twenty-two studies were finally included with a total of 11934 patients who underwent knee or hip replacement and 1841 developed POD with an incidence of 17.6% (95% confidential interval (CI) 13.2–22.0%). Eighteen significant risk factors were identified including advanced age (odds ratio (OR) 1.15 95% CI 1.08–1.22), cognitive impairment (OR 6.84, 95% CI 3.27–14.33), history of cerebrovascular events (OR 2.51, 95% CI 1.28–4.91), knee replacement (OR 1.42, 95% CI 1.00–2.02), blood loss (standardized mean difference (SMD) 0.30, 95% CI 0.15–0.44), dementia (OR 3.09, 95% CI 2.10–4.56), neurologic disorders (OR 2.26, 95% CI 1.23–4.15), psychiatric illness (OR 2.74, 95% CI 1.34–5.62), and obstructive sleep apnea (OR 4.17, 95% CI 1.72–10.09) along with several comorbidity evaluation scores and laboratory markers. Conclusion We identified risk factors consistently associated with the incidence of POD in knee and hip replacement. Strategies and interventions should be implemented to the patients receiving knee or hip replacement with potential risk factors identified in this meta-analysis.

Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

2018 ◽  
Vol 68 (12) ◽  
pp. 2875-2878
Author(s):  
Delia Rusu Andriesi ◽  
Ana Maria Trofin ◽  
Irene Alexandra Cianga Spiridon ◽  
Corina Lupascu Ursulescu ◽  
Cristian Lupascu
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Postoperative Pancreatic Fistula ◽  
University Center ◽  
Preoperative Hemoglobin ◽  
Term Administration ◽  
Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

scholarly journals Total pancreatectomy and pancreatic fistula: friend or foe?

2021 ◽  
Author(s):  
Roberto Salvia ◽  
Gabriella Lionetto ◽  
Giampaolo Perri ◽  
Giuseppe Malleo ◽  
Giovanni Marchegiani
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Total Pancreatectomy ◽  
Postoperative Pancreatic Fistula ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Surgical Morbidity ◽  
Pancreatic Anastomosis ◽  
Promising Tool

AbstractPostoperative 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.

Sign in / Sign up

Export Citation Format

Share Document