Risk Factors and Preventive Strategies for Post-operative Pancreatic Fistula After Pancreatic Surgery: a Comprehensive Review

Overview

Journal Scand J Gastroenterol

Publisher Informa Healthcare

Specialty Gastroenterology

Date 2016 May 25

PMID 27216233

Citations 24

Authors

Kjetil Soreide

Knut Jorgen Labori

Affiliations

Soon will be listed here.

Abstract

Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers.

Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF.

Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained.

Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.

Citing Articles

Development and validation of a novel pancreaticojejunostomy strategy based on the anatomical location of the main pancreatic duct that can reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy.

Xue K, Wang L, Chen L, Liu X, Li A, Wang Z Gland Surg. 2024; 13(10):1693-1707.

PMID: 39544981 PMC: 11558298. DOI: 10.21037/gs-24-235.

Pancreatic head resection for carcinoma of the ampulla vateri - better long-term prognosis, but more postoperative complications.

Kuesters S, Sundheimer J, Wittel U, Chikhladze S, Fichtner-Feigl S, Biesel E Langenbecks Arch Surg. 2024; 409(1):129.

PMID: 38632147 PMC: 11024026. DOI: 10.1007/s00423-024-03319-7.

A modified single-needle continuous suture of duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy.

Zhang B, Li L, Liu H, Li L, Wang H, Li Y Gland Surg. 2024; 12(12):1642-1653.

PMID: 38229848 PMC: 10788565. DOI: 10.21037/gs-23-340.

Serum amylase on postoperative day 1 is superior to serum lipase in predicting clinically relevant pancreatic fistula after partial pancreaticoduodenectomy.

Mintziras I, Wachter S, Manoharan J, Albers M, Kanngiesser V, Maurer E Langenbecks Arch Surg. 2023; 408(1):359.

PMID: 37714999 DOI: 10.1007/s00423-023-03090-1.

Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy: A systematic scoping review.

Robertson F, Spiers H, Lim W, Loveday B, Roberts K, Pandanaboyana S World J Gastrointest Surg. 2023; 15(8):1799-1807.

PMID: 37701689 PMC: 10494594. DOI: 10.4240/wjgs.v15.i8.1799.

References

Diener M, Fitzmaurice C, Schwarzer G, Seiler C, Huttner F, Antes G . Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 2014; (11):CD006053. PMC: 4356182. DOI: 10.1002/14651858.CD006053.pub5. View

Lei P, Fang J, Huang Y, Zheng Z, Wei B, Wei H . Pancreaticogastrostomy or pancreaticojejunostomy? Methods of digestive continuity reconstruction after pancreaticodudenectomy: a meta-analysis of randomized controlled trials. Int J Surg. 2014; 12(12):1444-9. DOI: 10.1016/j.ijsu.2014.10.024. View

Behrman S, Zarzaur B, Parmar A, Riall T, Hall B, Pitt H . Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications. J Gastrointest Surg. 2014; 19(1):72-9. PMC: 5543705. DOI: 10.1007/s11605-014-2608-z. View

Amico E, Alves J, Joao S, Guimaraes P, da Silva Barreto E, Silva Barreto L . Complications after pancreatectomies: prospective study after ISGFP and ISGPS new classifications. Arq Bras Cir Dig. 2013; 26(3):213-8. DOI: 10.1590/s0102-67202013000300011. View

Zhang H, Zhu F, Shen M, Tian R, Shi C, Wang X . Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg. 2014; 102(1):4-15. DOI: 10.1002/bjs.9653. View

cecka F, Lovecek M, Jon B, Skalicky P, Subrt Z, Neoral C . Intra-abdominal drainage following pancreatic resection: A systematic review. World J Gastroenterol. 2015; 21(40):11458-68. PMC: 4616221. DOI: 10.3748/wjg.v21.i40.11458. View

cecka F, Lovecek M, Jon B, Skalicky P, Subrt Z, Ferko A . DRAPA trial--closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial. Trials. 2015; 16:207. PMC: 4470087. DOI: 10.1186/s13063-015-0706-1. View

Israel J, Rettammel R, Leverson G, Hanks L, Cho C, Winslow E . Does postoperative drain amylase predict pancreatic fistula after pancreatectomy?. J Am Coll Surg. 2014; 218(5):978-87. DOI: 10.1016/j.jamcollsurg.2014.01.048. View

Li T, Luo L, Zhang C, Wang G, Chen Z, Jiang Z . End-to-End Invaginated Pancreaticojejunostomy with Three Overlapping U-Sutures--A Safe and Simple Method of Pancreaticoenteric Anastomosis. J Invest Surg. 2014; 28(2):115-9. DOI: 10.3109/08941939.2014.982313. View

10.

Diener M, Seiler C, Rossion I, Kleeff J, Glanemann M, Butturini G . Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet. 2011; 377(9776):1514-22. DOI: 10.1016/S0140-6736(11)60237-7. View

11.

cecka F, Jon B, Subrt Z, Ferko A . Surgical technique in distal pancreatectomy: a systematic review of randomized trials. Biomed Res Int. 2014; 2014:482906. PMC: 4058114. DOI: 10.1155/2014/482906. View

12.

Van Buren 2nd G, Bloomston M, Hughes S, Winter J, Behrman S, Zyromski N . A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg. 2013; 259(4):605-12. DOI: 10.1097/SLA.0000000000000460. View

13.

Vallance A, Young A, Macutkiewicz C, Roberts K, Smith A . Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review. HPB (Oxford). 2015; 17(11):1040-8. PMC: 4605344. DOI: 10.1111/hpb.12503. View

14.

Iacono C, Verlato G, Ruzzenente A, Campagnaro T, Bacchelli C, Valdegamberi A . Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg. 2013; 100(7):873-85. DOI: 10.1002/bjs.9136. View

15.

Xia X, Huang C, Cen G, Qiu Z . Preoperative diabetes as a protective factor for pancreatic fistula after pancreaticoduodenectomy: a meta-analysis. Hepatobiliary Pancreat Dis Int. 2015; 14(2):132-8. DOI: 10.1016/s1499-3872(15)60330-7. View

16.

Diener M, Tadjalli-Mehr K, Mehr K, Wente M, Kieser M, Buchler M . Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Langenbecks Arch Surg. 2010; 396(1):41-52. DOI: 10.1007/s00423-010-0716-0. View

17.

Kawai M, Hirono S, Okada K, Sho M, Nakajima Y, Eguchi H . Randomized Controlled Trial of Pancreaticojejunostomy versus Stapler Closure of the Pancreatic Stump During Distal Pancreatectomy to Reduce Pancreatic Fistula. Ann Surg. 2015; 264(1):180-7. PMC: 4902322. DOI: 10.1097/SLA.0000000000001395. View

18.

van der Gaag N, Harmsen K, Eshuis W, Busch O, van Gulik T, Gouma D . Pancreatoduodenectomy associated complications influence cancer recurrence and time interval to death. Eur J Surg Oncol. 2014; 40(5):551-558. DOI: 10.1016/j.ejso.2013.12.012. View

19.

Roberts K, Hodson J, Mehrzad H, Marudanayagam R, Sutcliffe R, Muiesan P . A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy. HPB (Oxford). 2013; 16(7):620-8. PMC: 4105899. DOI: 10.1111/hpb.12186. View

20.

Ansorge C, Nordin J, Lundell L, Strommer L, Rangelova E, Blomberg J . Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg. 2013; 101(2):100-8. DOI: 10.1002/bjs.9362. View