Dataset Information

Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It.

ABSTRACT: (1) Background: This study's goals were to investigate possible risk factors for clinically relevant postoperative pancreatic fistula (POPF) grade B/C according to the updated definitions of the International Study Group of Pancreatic Surgery and to analyze possible treatment strategies; (2) Methods: Between 2017 and 2021, 200 patients were analyzed regarding the development of POPF grade B/C with an emphasis on postoperative outcome and treatment strategies; (3) Results: POPF grade B/C was observed in 39 patients (19.5%). These patients were younger, mainly male, had fewer comorbidities and showed a higher body mass index. Also, they had lower CA-19 levels, a smaller tumor size and softer pancreatic parenchyma. They experienced a worse outcome without affecting the overall mortality rate (10% vs. 6%, p = 0.481), however, this lead to a prolonged postoperative stay (28 (32-36) d vs. 20 (15-28) d, p ≤ 0.001). The majority of patients with POPF grade B/C were able to receive conservative treatment, followed by drainage placement, endoscopic vacuum-assisted therapy (EVT) and surgery. Conservative treatment resulted in a shorter length of the postoperative stay (24 (22-28) d vs. 34 (26-43) d, p = 0.012); (4) Conclusions: Patients developing POPF grade B/C had a worse outcome; however, this did not affect the overall mortality rate. The majority of the patients were able to receive conservative treatment, resulting in a shorter length of their hospital stay.

SUBMITTER: Enderes J

PROVIDER: S-EPMC9952935 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It.

Enderes Jana J Pillny Christiane C Matthaei Hanno H Manekeller Steffen S Kalff Jörg C JC Glowka Tim R TR

Biology 20230122 2

(1) Background: This study's goals were to investigate possible risk factors for clinically relevant postoperative pancreatic fistula (POPF) grade B/C according to the updated definitions of the International Study Group of Pancreatic Surgery and to analyze possible treatment strategies; (2) Methods: Between 2017 and 2021, 200 patients were analyzed regarding the development of POPF grade B/C with an emphasis on postoperative outcome and treatment strategies; (3) Results: POPF grade B/C was obse ...[more]

PMID: 36829457

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Project description:BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD.MethodsWe searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test.ResultsA total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%-19%). Male (OR = 1.56, 95% CI: 1.42-1.70), body mass index >25 kg/m2 (OR = 1.98, 95% CI: 1.23-3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66-2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61-4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01-4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47-0.61), vascular resection (OR = 0.57, 95% CI: 0.39-0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57-0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40-1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis.ConclusionsThe current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.

Project description:BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) remains a significant complication after pancreaticoduodenectomy (PD), leading to prolonged hospital stays, increased healthcare costs, and higher mortality rates. Timely recognition of patients at high risk for CR-POPF is critical for the implementation of personalized management strategies. This study aimed to develop and validate a predictive nomogram using preoperative factors to accurately predict CR-POPF after PD.MethodsA total of 262 consecutive patients who underwent PD between February 2021 and December 2022 at a single institution were enrolled and divided into a training cohort (n=209) and a validation cohort (n=53). Preoperative risk factors for CR-POPF were identified through least absolute shrinkage and selection operator (LASSO) regression and further evaluated using univariate and multivariate logistic regression models. A predictive nomogram was constructed based on the training cohort and validated internally using the validation cohort, with additional cross-validation. The nomogram's discriminative performance was evaluated using the area under the curve (AUC), sensitivity, specificity, calibration curves, and decision curve analysis (DCA).ResultsOverall, 36.2% (n=95) patients developed CR-POPF. The nomogram identified several preoperative factors, including triglycerides (TGs), neutrophils, the size of the main pancreatic duct (MPD), pancreatic index (PI), and thickness of the pancreas (TP), as independent risk factors for CR-POPF. Internal and cross-validation of receiver operating characteristic (ROC) curves yielded statistically significant results (AUC =0.761 and 0.812, respectively). Calibration curves demonstrated strong agreement between the nomogram's predictions and actual outcomes. DCA confirmed the nomogram's substantial clinical relevance. The sensitivity and specificity of the nomogram in the validation cohort were 60.9% and 90.0%, respectively.ConclusionsThis predictive nomogram, based on preoperative risk factors such as TG, neutrophils, the size of MPD, PI, and TP, provides a simple and accurate method for predicting CR-POPF after PD, aiding clinicians in identifying high-risk patients and optimizing preoperative management strategies to improve decision-making.

Dataset Information

Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It.

Publications

Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It.

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