Pancreatic fistulae: are we making progress?
Zoe E Parr1, Francis R Sutherland, Oliver F Bathe
1Division of General Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Insights
Pancreatic fistulae definitions lack standardization, and current parameters do not predict patient morbidity or mortality. A new system is needed to accurately identify and assess the clinical significance of pancreatic fistulae after surgery.
Area of Science:
- Gastroenterology
- Surgical Outcomes Research
- Clinical Definitions
Background:
- Pancreatic fistulae are a significant complication following pancreatic surgery.
- A universally accepted definition for pancreatic fistulae is currently lacking.
- This absence hinders reliable reporting and comparative studies of surgical outcomes.
Purpose of the Study:
- To compare reported rates of pancreatic fistulae, morbidity, and mortality.
- To evaluate existing fistula parameters for their predictive value of adverse outcomes.
- To identify high-risk pancreatic fistulae associated with morbid outcomes.
Main Methods:
- Systematic literature review of 1426 identified articles.
- Inclusion and exclusion criteria applied, resulting in 43 reviewed articles.
- Extraction and comparison of fistula definitions, morbidity, and mortality rates.
Main Results:
- Thirty-two distinct definitions of pancreatic fistulae were identified across 43 articles.
- Only 24 articles utilized comprehensive definitions including all examined parameters.
- Drainage volume, amylase levels, and drainage duration did not correlate with morbidity or mortality.
Conclusions:
- Current parameters used to define pancreatic fistulae may not correlate with patient morbidity and mortality.
- Existing definitions are insufficient for accurately assessing the clinical significance of pancreatic fistulae.
- A novel classification system is required to better identify and manage pancreatic fistulae.
Background/Purpose:
Pancreatic fistulae constitute a morbid outcome of pancreatic surgery. Yet, a definition of a pancreatic fistula does not exist that can be reliably used to report on and study this outcome. We compare reported fistula, morbidity, and mortality rates with fistula parameters in order to identify high-risk fistulae predictive of morbid outcomes.
Methods:
A systematic literature review was performed; of 1426 articles identified, 43 articles ultimately met inclusion and exclusion criteria and were reviewed. Fistula, morbidity, and mortality rates as well as fistula definitions were extracted and then compared and graphically reported.
Results:
Thirty-two different definitions of pancreatic fistulae were found in 43 articles; only 24 articles defined fistulae according to all three parameters examined in this study. The data trends suggest that fistula, morbidity, and mortality rates have remained relatively stable since 1980. Further, drainage volumes, amylase levels, and length of drainage do not appear to correlate with reported morbidity or mortality rates.
Conclusions:
This study suggests that pancreatic fistulae may not correlate with morbidity and mortality. Further, the parameters historically used to define fistulae do not appear to correlate with morbidity and mortality. A different system is needed to identify this outcome and determine its clinical significance.
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