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pancreatic fistula after central pancreatectomy: case series and review of the literature

Hepatobiliary & pancreatic Diseases International 2014年第2期13卷 203-208页

作者： Yan-Ming Zhou Xiao-Feng Zhang Lu-Peng Wu Xu Su Bin Li Le-Hua Shi Department of Hepatobiliary & Pancreatovascular Surgery First Affiliated Hospital of Xiamen University Oncologic Center of Xiamen The 4th Department of Hepatic Surgery Eastern Hepatobiliary Surgery Hospital Second Military Medical University

BACKGROUND: Postoperative pancreatic fistula is one of the most common complications after pancreatectomy. This study aimed to assess the occurrence and severity of pancreatic fistula after central pancreatectomy.METHODS: The medical records of 13 patients who had undergone central pancreatectomy were retrospectively studied together with a literature review of studies including at least five cases of central pancreatectomy. pancreatic fistula was defined and graded according to the recommendations of the International Study Group on pancreatic fistula (ISGPF).RESULTS: No death was observed in the 13 patients. pancreatic fistula developed in 7 patients and was successfully treated nonoperatively. None of these patients required re-operation. A total of 40 studies involving 867 patients who underwent central pancreatectomy were reviewed. The overall pancreatic fistula rate of the patients was 33.4% (0-100%). Of 279 patients, 250(89.6%) had grade A or B fistulae of ISGPF and were treated nonoperatively, and the remaining 29 (10.4%) had grade C fistulae of ISGPF. In 194 patients, 15 (7.7%) were re-operated upon. Only one patient with grade C fistula of ISGPF died from multiple organ failure after re-operation.CONCLUSION: Despite the relatively high occurrence, most pancreatic fistulae after central pancreatectomy are recognized a grade A or B fistula of ISGPF, which can be treated conservatively or by mini-invasive approaches.

关键词： pancreas central pancreatectomy pancreatic fistula

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pancreatic fistula may be an important complication following spleen-preserving radical gastrectomy with dissection of No.10 and No.11 lymph nodes

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Chinese Medical Journal 2010年第15期123卷 2135-2137页

作者： ZHANG Jun ZHANG Zhong-tao WANG Yu WANG Kang-li Department of General Surgery Beijing Friendship Hospital Affiliated to Capital Medical University Beijing 100050 China

In recent years, spleen-preserving radical gastrectomy with dissection of No.10 and No.11 lymph nodes has been gradually accepted because of an improved understanding of immune function of the spleen in the perioperat... 详细信息

关键词： pancreatic fistula gastrectomy postoperative complications

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Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

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Frontiers of Medicine 2020年第3期14卷 251-261页

作者： Li Jiang Deng Ning Xiao-ping Chen Department of Biliary and pancreatic Surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Hepatic Surgery Center Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection.How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved.Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis.According to the literature,identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication.Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice.After the occurrence of POPF,the treatment of choice should be determined according to the classification of the pancreatic fistula.However,despite the progress and promising treatment approaches,POPF remains to be a clinical issue that warrants further studies in the future.

关键词： pancreatic fistula pancreatic body and tail resection distal pancreatectomy

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Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe morbidity and pancreatic fistula after pancreatoduodenectomy

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Hepatobiliary & pancreatic Diseases International 2020年第1期19卷 58-67页

作者： Mario Rodriguez-Lopez Francisco J.Tejero-Pintor Martin Bailon-Cuadrado Asterio Barrera-Rebollo Baltasar Perez-Saborido David Pacheco-Sanchez General and Digestive Surgery Department Rio-Hortega University Hospital

Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.

关键词： Pancreatoduodenectomy Morbidity pancreatic fistula Biomarker Prediction Score

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pancreatic parenchymal injection of ethanol and octreotide to induce focal pancreatic fibrosis in rats: Strategies to eliminate postoperative pancreatic fistula

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Hepatobiliary & pancreatic Diseases International 2018年第1期17卷 81-85页

作者： Soo Ho Lee Tae Ho Hong Department of Surgery Uijeongbu St.Mary’s Hospital College of Medicine The Catholic University of Korea Department of Surgery Seoul St.Mary’s Hospital College of Medicine The Catholic University of Korea

Background: Postoperative pancreatic fistula(POPF) is more likely to occur in a soft pancreas compared to a hard pancreas in which fibrosis has progressed. There is almost no leakage at the anastomosis site or cut surface of a hard pancreas. The aim of this study was to induce localized fibrosis at the cut surface of the pancreas in a rat model.Methods: Thirty-six rats were divided into three groups(group S: normal saline group; group E: ethanol group; and group O: octreotide group). Each rat was directly injected with a particular compound at the duodenal lobe of the pancreatic parenchyma. Each group was divided into three subgroups according to the time of post-injection sacrifice(1, 2, or 4 weeks). The hardness, suture holding capacity(SHC), and histological fibrosis grade of each pancreas were measured.Results: The hardness, SHC, and fibrosis grade of groups E and O were increased at week 1, with greater increases in group E(all P pancreatic fibrosis. Unlike octreotide, ethanol provoked localized fibrosis that was maintained over time. It is expected that ethanol injection could eliminate POPF during pancreatic surgery.

关键词： Ethanol Octreotide pancreatic fibrosis pancreatic fistula Rat model

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Total closure of pancreatic section for end-to-side pancreaticojejunostomy decreases incidence of pancreatic fistula in pancreaticoduodenectomy

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Hepatobiliary & pancreatic Diseases International 2017年第3期16卷 310-314页

作者： Yu-Ling Sun Ya-Lei Zhao Wen-Qi Li Rong-Tao Zhu Wei-Jie Wang Jian Li Shuai Huang Xiu-Xian Ma Department of Hepatobiliary and pancreatic Surgery the First Affiliated Hospital of Zhengzhou University Zhengzhou 450052 China Institute of Hepatobiliary and pancreatic Diseases Zheng- zhou University Zhengzhou 450052 China

BACKGROUND： Postoperative pancreatic fistula （POPF） is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy （PD）. METHODS： This was a prospective randomized clinical trial comparing the outcomes of PD between patients who un- derwent total closure of pancreatic section for end-to-side pancreaticojejunostomy （Group A） vs those who underwent conventional pancreaticojejunostomy （Group B）. The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. RESULTS： One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B （4.8% vs 16.7%, P〈0.05）. About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A （P〈0.01）. The wound/abdomi- nal infection rate was also much higher in Group B than that in Group A （20.0% vs 6.3%, P〈0.05）. Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively （P〈0.001）. However, there was no difference in the probability of mortality, biliary leakage,delayed gastric emptying, and pulmonary infection between the two groups. CONCLUSION： Total closure of pancreatic section for end-to- side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.

关键词： periampullary tumor pancreatic fistula pancreaticoduodenectomy pancreaticojejunostomy biliary leakage

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Risk factors for pancreatic fistula following pancreaticoduodenectomy: A retrospective study in a Thai tertiary center

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World Journal of Gastrointestinal Surgery 2017年第12期9卷 270-280页

作者： Narongsak Rungsakulkij Somkit Mingphruedhi Pongsatorn Tangtawee Chonlada Krutsri Paramin Muangkaew Wikran Suragul Penampai Tannaphai Suraida Aeesoa Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University Department of Radiology Faculty of Medicine Ramathibodi HospitalMahidol University

AIM To analyze the risk factors of postoperative pancreatic fistula following pancreaticoduodenectomy in a Thai tertiary care center.METHODS We retrospectively analyzed 179 patients who underwent pancreaticoduodenectomy at our hospital from January 2001 to December 2016. pancreatic fistula were classified into three categories according to a definition made by an International Study Group on pancreatic fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS pancreatic fistula were detected in 88/179 patients(49%) who underwent pancreaticoduodenectomy. Fifty-eight pancreatic fistula(65.9%) were grade A, 22 cases(25.0%) were grade B and eight cases(9.1%) were grade C. Clinically relevant pancreatic fistula were detected in 30/179 patients(16.7%). The 30-d mortality rate was 1.67%(3/179 patients). Multivariate logistic regression analysis revealed that soft pancreatic texture(odds ratio = 3.598, 95%CI: 1.77-7.32) was the most significant risk factor for pancreatic fistula. A preoperative serum bilirubin level of > 3 mg/d L was the most significant risk factor for clinically relevant pancreatic fistula according to univariate and multivariate analysis.CONCLUSION Soft pancreatic tissue is the most significant risk factor for postoperative pancreatic fistula. A high preoperative serum bilirubin level(> 3 mg/d L) is the most significant risk factor for clinically relevant pancreatic fistula.

关键词： Risk factors pancreatic fistula Pancreas Pancreatectomy pancreaticoduodenectomy

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Brachiocephalic to left brachial vein thrombotic vasculitis accompanying mediastinal pancreatic fistula:A case report

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World Journal of Clinical Cases 2022年第32期10卷 11882-11888页

作者： Reiji Kokubo Daisuke Yunaiyama Yu Tajima Natsumi Kugai Mitsuru Okubo Kazuhiro Saito Takayoshi Tsuchiya Takao Itoi Department of Radiology Tokyo Medical UniversityTokyo 160-0023Japan Department of Gastroenterology and Hepatology Tokyo Medical UniversityTokyo 160-0023Japan

BACKGROUND Pancreatitis is a severe inflammatory pancreatic disease commonly due to bile duct stones or excessive alcohol usage,with clinical manifestations of abdominal pain,nausea,fever,and fluid collections.Healthy persons with less symptomatic pancreatitis are quite rare.Herein,we report a case of a patient with an undetermined onset of pancreatitis mimicking left arm cellulitis due to thrombotic vasculitis of the brachiocephalic vein.CASE SUMMARY A 50-year-old woman visited our hospital for tenderness in the left arm over several recent days.She was diagnosed with cellulitis on the left arm due to left elbow tenderness.Intravenous antibiotics administration did not improve symptoms and laboratory data worsened;thus,chest and abdominal computed tomography(CT)was performed.CT demonstrated pancreatitis with pseudocyst around the pancreas extending to the mediastinum.Thrombotic vasculitis of the brachiocephalic to left brachial vein was observed,which could be the cause of left elbow pain.A pancreatic fistula was found in the head of the pancreas by endoscopic retrograde cholangiopancreatography,so a pancreatic cyst drainage tube via the duodenum was placed in the pseudocyst.Cyst content culture was positive for Escherichia coli infection.Clinical symptoms,imaging findings,and inflammatory reactions resolved gradually after starting therapeutic intervention.The mediastinal pancreatic pseudocysts shrunk,and the venous thrombi remained but shrunk.CONCLUSION The case of a patient with pancreatitis with an undetermined onset that mimics left arm cellulitis is reported.Deep vein thrombosis should be kept in mind when treating patients with severe inflammatory disease.

关键词： pancreatic fistula Thrombotic vasculitis Pancreatitis Computed tomography Case report

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Personal predictive model based on systemic inflammation markers for estimation of postoperative pancreatic fistula following pancreaticoduodenectomy

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 963-975页

作者： Zhi-Da Long Chao Lu Xi-Gang Xia Bo Chen Zhi-Xiang Xing Lei Bie Peng Zhou Zhong-Lin Ma Rui Wang Department of Hepatobiliary and pancreaticosplenic Surgery Jingzhou HospitalYangtze UniversityJingzhou 434020Hubei ProvinceChina Department of Hepatobiliary Surgery Lu’an Hospital of AnHui Medical UniversityHefei 237006Anhui ProvinceChina

BACKGROUND Postoperative pancreatic fistula(PF)is a serious life-threatening complication after pancreaticoduodenectomy(PD).Our research aimed to develop a machine learning(ML)-aided model for PF risk stratification.AIM To develop an ML-aided model for PF risk stratification.METHODS We retrospectively collected 618 patients who underwent PD from two tertiary medical centers between January 2012 and August 2021.We used an ML algorithm to build predictive models,and subject prediction index,that is,decision curve analysis,area under operating characteristic curve(AUC)and clinical impact curve to assess the predictive efficiency of each model.RESULTS A total of 29 variables were used to build the ML predictive model.Among them,the best predictive model was random forest classifier(RFC),the AUC was[0.897,95%confidence interval(CI):0.370–1.424],while the AUC of the artificial neural network,eXtreme gradient boosting,support vector machine,and decision tree were between 0.726(95%CI:0.191–1.261)and 0.882(95%CI:0.321–1.443).CONCLUSION Fluctuating serological inflammatory markers and prognostic nutritional index can be used to predict postoperative PF.

关键词： Pancreatoduodenectomy pancreatic fistula Machine learning algorithm Systemic inflammatory biomarker Risk prediction

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Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy:A propensity score-matched study

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 482-493页

作者： Yang Li Yun Liang Yao Deng Zhi-Wei Cai Ming-Jian Ma Long-Xiang Wang Meng Liu Hong-Wei Wang Chong-Yi Jiang Department of General Surgery Huadong Hospital Affiliated to Fudan UniversityShanghai 200040China Department of pancreatic Surgery Fudan University Shanghai Cancer CenterShanghai 200032China

BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Although several methods have attempted to reduce the postoperative pancreatic fistula(POPF)rate after PD,few have been considered effective.The safety and short-term clinical benefits of omental interposition remain controversial.AIM To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODS In total,196 consecutive patients underwent PD performed by the same surgical team.The patients were divided into two groups:An omental interposition group(127,64.8%)and a non-omental interposition group(69,35.2%).Propensity scorematched(PSM)analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTS Following PSM,the clinically relevant POPF(CR-POPF,10.1%vs 24.6%;P=0.025)and delayed postpancreatectomy hemorrhage(1.4%vs 11.6%;P=0.016)rates were significantly lower in the omental interposition group.The omental interposition technique was associated with a shorter time to resume food intake(7 d vs 8 d;P=0.048)and shorter hospitalization period(16 d vs 21 d;P=0.031).Multivariate analyses showed that a high body mass index,nonapplication of omental interposition,and a main pancreatic duct diameter<3 mm were independent risk factors for CR-POPF.CONCLUSION The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.

关键词： pancreaticoduodenectomy pancreatic fistula Complication Omental interposition

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