Pancreatoduodenectomy: Risk Factors of Postoperative Pancreatic Fistula
Insights
This study analyzed risk factors for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). While anastomosis techniques showed no difference, soft pancreatic texture and non-dilated pancreatic ducts were associated with higher POPF rates.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pancreatic Surgery
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication following pancreatoduodenectomy (PD).
- Identifying risk factors and understanding clinical outcomes are crucial for improving patient management.
Purpose of the Study:
- To analyze risk factors associated with postoperative pancreatic fistula (POPF).
- To evaluate the clinical outcomes after pancreatoduodenectomy (PD).
Main Methods:
- Retrospective multicentric review of 138 patients who underwent PD between January 2003 and July 2013.
- Patients were categorized into three groups based on different anastomosis techniques: invaginating end-to-end pancreatojejunostomy, end-to-side pancreatojejunostomy with duct-to-mucosa anastomosis, and end-to-side pancreatogastrostomy.
Main Results:
- The overall incidence of POPF was 21%, with variations across anastomosis groups (16% to 27%).
- POPF occurred more frequently in patients with soft pancreatic texture (40%) and non-dilated pancreatic ducts (30.8%).
- Overall 1 and 3-year survival rates after PD were 69% and 48%, respectively, with perioperative mortality at 5.8%.
Conclusions:
- Surgical anastomosis techniques did not significantly impact POPF rates.
- Soft pancreatic texture appears to increase POPF risk, while a dilated pancreatic duct may decrease it.
- POPF increases morbidity but does not significantly affect overall survival, which is primarily influenced by tumor histopathology.
Background/Aims:
The aim of the present study is the analysis of risk factors of postoperative pancreatic fistula (POPF) and of clinical outcome after pancreatoduodenectomy (PD) in a retrospective multicentric review of the patient cohort.
Methodology:
From January 2003 to July 2013 143 patients underwent PD: 138 cases were included and 3 groups were identified according to the different types of anastomosis: Group 1 invaginating end-to-end pancreatojejunostomy, Group 2 end-to-side pancreatojejunostomy with duct-to-mucosa anastomosis, Group 3 end-to-side pancreatogastrostomy.
Results:
Twenty-one % of patients developed POPF, 16% in Group 1, 27% in Group 2, 12% in Group 3. Forty % grade A, 13% grade B and 47% grade C total POPF. It results that POPF occurred in 16% of hard and in 40% of soft pancreatic texture; in 11.4% of dilated Wirsung versus 30.8% of non dilated (p = 0.007). Overall actuarial 1 and 3 year survival after PD is 69% and 48% respectively. Perioperative mortality is 5.8% overall, 17.85% for grade C.
Conclusions:
No differences have been found among surgical anastomosis techniques. Soft tissues seem to increase, while dilated Wirsung seems to decrease POPF rate. The development of POPF increase morbidity but it doesn't affect overall survival, more strictly related to tumour histopathology.
