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Impact of postoperative pancreatic fistula on surgical outcome--the need for a classification-driven risk management

Andreas Schmid Frymerman1, Jochen Schuld, Patrick Ziehen

  • 1Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421 Homburg, Saar, Germany.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|January 23, 2010
PubMed

Insights

Postoperative pancreatic fistula (POPF) Type C is linked to severe complications and mortality. Soft pancreatic consistency and high drain lipase activity on postoperative day 3 predict POPF Type C development.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Clinical Research

Background:

  • The International Study Group of Pancreatic Fistula (ISGPF) classification aids POPF incidence and severity comparison.
  • The ISGPF classification lacks post hoc guidance for individual POPF treatment.
  • This study investigates POPF Types A-C's association with secondary surgical morbidity and mortality.

Purpose of the Study:

  • To determine the impact of POPF Types A-C on secondary surgical morbidity and mortality.
  • To identify predictors for the development of POPF Type C.

Main Methods:

  • Analysis of 483 patients undergoing pancreatic resections between 3/2001-12/2007.
  • Prospective data collection and classification of POPF according to ISGPF criteria.
  • Statistical analysis of POPF association with surgical complications and mortality.

Main Results:

  • POPF patients experienced significantly more vascular complications than non-POPF patients.
  • POPF Type C was associated with significant surgical complications (17 vascular) and mortality (5/29).
  • Soft pancreatic consistency (OR 8.5) and high drain lipase activity on postoperative day 3 (OR 4.4) predicted POPF Type C.

Conclusions:

  • POPF Type C correlates with severe vascular complications, delayed gastric emptying, and pleural effusions.
  • Soft pancreatic consistency and elevated postoperative day 3 drain lipase activity are early predictors of POPF Type C.
  • Understanding these predictors can guide early intervention for POPF Type C.
Abstract

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