Risk factors of pancreatic fistula after distal pancreatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Shangqing , WANG Feitong , LIU Xing ,  LIU Bin

Department of Tumor Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

LIU Bin, Email: xyfyzlwk@163.com

Keywords：

postoperative pancreatic fistula; distal pancreatectomy; pancreatic plain scan CT value; risk factor

DOI：

10.7507/1007-9424.201804023

Video：

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Objective To analyze the risk factors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) and to explore the effective index of predicting POPF after DP. Methods The clinical data of 120 patients with pancreatic disease who were treated with DP in the Department of Tumor Surgery of Xuzhou Medical University from January 2010 to November 2017 were analyzed retrospectively. The influencing factors of POPF after DP were analyzed by non-conditional logistic regression. Results Of the 120 patients, 15 patients (12.5%) had clinically significant POPF, including 13 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The results of non-conditional logistic regression showed that, the soft pancreas and preoperative pancreatic CT value of the pancreas less than 40 Hu were the independent risk factors of POPF after DP (P<0.05). Conclusions Pancreatic texture and preoperative CT value are important factors influencing the occurrence of POPF after DP. Evaluating the preoperative CT value and intraoperative pancreatic texture can effectively predict the risk of POPF after DP.

Citation： WANG Shangqing, WANG Feitong, LIU Xing, LIU Bin. Risk factors of pancreatic fistula after distal pancreatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(10): 1201-1205. doi: 10.7507/1007-9424.201804023 Copy

1.	Parikh PY, Lillemoe KD. Surgical management of pancreatic cancer-distal pancreatectomy. Semin Oncol, 2015, 42(1): 110-122.
2.	Probst P, Hüttner FJ, Klaiber U, et al. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev, 2015, (11): CD008688.
3.	Fernández-Cruz L, Poves I, Pelegrina A, et al. Laparoscopic distal pancreatectomy for pancreatic tumors: does size matter? Dig Surg, 2016, 33(4): 290-298.
4.	Yu L, Huang Q, Xie F, et al. Risk factors of postoperative complications of pancreatoduodenectomy. Hepatogastroenterology, 2014, 61(135): 2091-2095.
5.	胡元国, 黄强. 胰体尾癌的诊治: 附45例报告. 中国普通外科杂志, 2015, 24(3): 343-346.
6.	Miyasaka Y, Mori Y, Nakata K, et al. Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy. Surg Today, 2017, 47(4): 416-424.
7.	陈永亮, 黄志强, 董家鸿, 等. 远端胰腺切除术后并发症及死亡的危险因素分析. 中华医学杂志, 2015, 95(2): 96-99.
8.	王小龙, 涂彦渊, 王巍, 等. 胰十二指肠切除术后胰瘘发生的危险因素分析. 临床肝胆病杂志, 2017, 33(1): 116-120.
9.	王高卿, 陆才德, 虞伟明, 等. 胰体尾切除术后胰瘘的危险因素分析. 中华普通外科杂志, 2015, 30(5): 344-347.
10.	安勇, 蔡辉华, 江勇, 等. 腹腔镜下胰体尾切除术术后胰瘘的危险因素分析. 江苏医药, 2017, 43(21): 1535-1538.
11.	Roberts KJ, Storey R, Hodson J, et al. Pre-operative prediction of pancreatic fistula: is it possible? Pancreatology, 2013, 13(4): 423-428.
12.	Chang YR, Kang JS, Jang JY, et al. Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg, 2017, 41(6): 1610-1617.
13.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
14.	Tanaka K, Tomita H, Osada S, et al. Significance of histo- pathological evaluation of pancreatic fibrosis to predict postoperative course after pancreatic surgery. Anticancer Res, 2015, 35(3): 1749-1756.
15.	Ecker BL, McMillan MT, Allegrini V, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy: analysis of 2 026 resections from the international, multi-institutional distal pancreatectomy study group. Ann Surg, 2017, [Epub ahead of print].
16.	McMillan MT, Malleo G, Bassi C, et al. Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg, 2017, 265(6): 1209-1218.
17.	Xia T, Zhou JY, Mou YP, et al. Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon. PLoS One, 2017, 12(2): e0172857.
18.	Peng YP, Zhu XL, Yin LD, et al. Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep, 2017, 7(1): 185.
19.	Fukuda Y, Yamada D, Eguchi H, et al. A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure. Surg Today, 2017, 47(10): 1180-1187.
20.	Deng Y, Zhao B, Yang M, et al. Association between the incidence of pancreatic fistula after pancreaticoduodenectomy and the degree of pancreatic fibrosis. J Gastrointest Surg, 2018, 22(3): 438-443.
21.	Hanaki T, Uejima C, Amisaki M, et al. The attenuation value of preoperative computed tomography as a novel predictor for pancreatic fistula after pancreaticoduodenectomy. Surg Today, 2018, 48(6): 598-608.
22.	余淼, 王亚东, 薛焕洲, 等. 术前 CT 指标预测胰十二指肠切除术后胰瘘风险的可行性分析. 中华医学杂志, 2017, 97(30): 2362-2365.
23.	杨美文, 邓永, 黄涛, 等. 胰十二指肠切除术后胰瘘与胰腺纤维化程度相关关系的临床研究. 中华外科杂志, 2017, 55(5): 373-377.
24.	Weber SM, Cho CS, Merchant N, et al. Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol, 2009, 16(10): 2825-2833.
25.	Unek T, Egeli T, Ozbilgin M, et al. Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy. Hepatogastroenterology, 2013, 60(127): 1778-1784.
26.	Hassenpflug M, Hinz U, Strobel O, et al. Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER Randomized Controlled Trial). Ann Surg, 2016, 264(5): 723-730.

1. Parikh PY, Lillemoe KD. Surgical management of pancreatic cancer-distal pancreatectomy. Semin Oncol, 2015, 42(1): 110-122.
2. Probst P, Hüttner FJ, Klaiber U, et al. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev, 2015, (11): CD008688.
3. Fernández-Cruz L, Poves I, Pelegrina A, et al. Laparoscopic distal pancreatectomy for pancreatic tumors: does size matter? Dig Surg, 2016, 33(4): 290-298.
4. Yu L, Huang Q, Xie F, et al. Risk factors of postoperative complications of pancreatoduodenectomy. Hepatogastroenterology, 2014, 61(135): 2091-2095.
5. 胡元国, 黄强. 胰体尾癌的诊治: 附45例报告. 中国普通外科杂志, 2015, 24(3): 343-346.
6. Miyasaka Y, Mori Y, Nakata K, et al. Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy. Surg Today, 2017, 47(4): 416-424.
7. 陈永亮, 黄志强, 董家鸿, 等. 远端胰腺切除术后并发症及死亡的危险因素分析. 中华医学杂志, 2015, 95(2): 96-99.
8. 王小龙, 涂彦渊, 王巍, 等. 胰十二指肠切除术后胰瘘发生的危险因素分析. 临床肝胆病杂志, 2017, 33(1): 116-120.
9. 王高卿, 陆才德, 虞伟明, 等. 胰体尾切除术后胰瘘的危险因素分析. 中华普通外科杂志, 2015, 30(5): 344-347.
10. 安勇, 蔡辉华, 江勇, 等. 腹腔镜下胰体尾切除术术后胰瘘的危险因素分析. 江苏医药, 2017, 43(21): 1535-1538.
11. Roberts KJ, Storey R, Hodson J, et al. Pre-operative prediction of pancreatic fistula: is it possible? Pancreatology, 2013, 13(4): 423-428.
12. Chang YR, Kang JS, Jang JY, et al. Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg, 2017, 41(6): 1610-1617.
13. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
14. Tanaka K, Tomita H, Osada S, et al. Significance of histo- pathological evaluation of pancreatic fibrosis to predict postoperative course after pancreatic surgery. Anticancer Res, 2015, 35(3): 1749-1756.
15. Ecker BL, McMillan MT, Allegrini V, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy: analysis of 2 026 resections from the international, multi-institutional distal pancreatectomy study group. Ann Surg, 2017, [Epub ahead of print].
16. McMillan MT, Malleo G, Bassi C, et al. Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg, 2017, 265(6): 1209-1218.
17. Xia T, Zhou JY, Mou YP, et al. Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon. PLoS One, 2017, 12(2): e0172857.
18. Peng YP, Zhu XL, Yin LD, et al. Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep, 2017, 7(1): 185.
19. Fukuda Y, Yamada D, Eguchi H, et al. A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure. Surg Today, 2017, 47(10): 1180-1187.
20. Deng Y, Zhao B, Yang M, et al. Association between the incidence of pancreatic fistula after pancreaticoduodenectomy and the degree of pancreatic fibrosis. J Gastrointest Surg, 2018, 22(3): 438-443.
21. Hanaki T, Uejima C, Amisaki M, et al. The attenuation value of preoperative computed tomography as a novel predictor for pancreatic fistula after pancreaticoduodenectomy. Surg Today, 2018, 48(6): 598-608.
22. 余淼, 王亚东, 薛焕洲, 等. 术前 CT 指标预测胰十二指肠切除术后胰瘘风险的可行性分析. 中华医学杂志, 2017, 97(30): 2362-2365.
23. 杨美文, 邓永, 黄涛, 等. 胰十二指肠切除术后胰瘘与胰腺纤维化程度相关关系的临床研究. 中华外科杂志, 2017, 55(5): 373-377.
24. Weber SM, Cho CS, Merchant N, et al. Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol, 2009, 16(10): 2825-2833.
25. Unek T, Egeli T, Ozbilgin M, et al. Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy. Hepatogastroenterology, 2013, 60(127): 1778-1784.
26. Hassenpflug M, Hinz U, Strobel O, et al. Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER Randomized Controlled Trial). Ann Surg, 2016, 264(5): 723-730.

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Risk factors of pancreatic fistula after distal pancreatectomy

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