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Pancreatic Anastomotic Leakage After Pancreaticoduodenectomy. Risk Factors, Clinical Predictors, And Management (Single Center Experience)

A. El Nakeeb, T. Salah, Ahmad Sultan, Mohamed El Hemaly, Waleed Askr, Helmy Ezzat, E. Hamdy, E. Atef, E. El hanafy, A. Elgeidie, M. Abdel Wahab, T. Abdallah
Published 2013 · Medicine

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BackgroundPostoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a challenge even at high-volume centers.MethodsThis study was designed to analyze perioperative risk factors for POPF after PD and evaluate the factors that predict the extent and severity of leak. Demographic data, preoperative, intraoperative, and postoperative variables were collected.ResultsA total of 471 consecutive patients underwent PD in our center. Fifty-seven patients (12.1 %) developed a POPF of any type; 21 patients (4.5 %) had a fistula type A, 22 patients (4.7 %) had a fistula type B, and the remaining 14 patients (3 %) had a POPF type C. Cirrhotic liver (P = 0.05), BMI > 25 kg/m2 (P = 0.0001), soft pancreas (P = 0.04), pancreatic duct diameter <3 mm (0.0001), pancreatic duct located <3 mm from the posterior border (P = 0.02) were significantly associated with POPF. With the multivariate analysis, both BMI and pancreatic duct diameter were demonstrated to be independent factors. The hospital mortality in this series was 11 patients (2.3 %), and the development of POPF type C was associated with a significantly increased mortality (7/14 patients). The following factors were predictors of clinically evident POPF: a postoperative day (POD) 1 and 5 drain amylase level >4,000 IU/L, WBC, pancreatic duct diameter <3 mm, and pancreatic texture.ConclusionsCirrhotic liver, BMI, soft pancreas, pancreatic duct diameter <3 mm, pancreatic duct near the posterior border are risk factors for development of POPF. In addition a drain amylase level >4,000 IU/L on POD 1 and 5, WBC, pancreatic duct diameter, pancreatic texture may be predictors of POPF B, C.
This paper references
10.1007/s11605-009-1147-5
Impact of Postoperative Pancreatic Fistula on Surgical Outcome—The Need for a Classification-driven Risk Management
Andreas Schmid Frymerman (2009)
10.1186/1471-2482-12-3
Ultrasonic scalpel causes greater depth of soft tissue necrosis compared to monopolar electrocautery at standard power level settings in a pig model
Kia Homayounfar (2012)
10.1016/j.gassur.2006.07.020
Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial
J. Winter (2007)
10.3748/WJG.V11.I16.2456
Risk factors of pancreatic leakage after pancreaticoduodenectomy.
Yin-mo Yang (2005)
10.1111/j.1477-2574.2009.00051.x
Is isolated Roux loop pancreaticojejunostomy superior to conventional reconstruction in pancreaticoduodenectomy?
A. Perwaiz (2009)
10.1007/PL00013170
Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy: Critical Analysis of 221 Resections
T. Böttger (1999)
10.1001/ARCHSURG.139.7.718
Pancreaticoduodenectomy: a 20-year experience in 516 patients.
C. Schmidt (2004)
10.1016/S1072-7515(01)00819-5
The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.
M. Sewnath (2001)
10.1097/01.sla.0000251708.70219.d2
Clinical and Economic Validation of the International Study Group of Pancreatic Fistula (ISGPF) Classification Scheme
W. Pratt (2007)
10.1002/bjs.5047
Incidence and management of pancreatic leakage after pancreatoduodenectomy
S. D. de Castro (2005)
10.1016/S0039-6060(03)00345-3
Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial.
C. Bassi (2003)
10.1016/S1072-7515(03)00331-4
Zero mortality after 152 consecutive pancreaticoduodenectomies with pancreaticogastrostomy.
G. Aranha (2003)
10.1007/s11605-007-0258-0
Pancreatojejunal Leakage After Pancreas Head Resection: Anatomic and Surgeon-Related Factors
O. Kollmar (2007)
10.1002/bjs.1800810839
Preoperative endoscopic drainage for malignant obstructive jaundice
E. Lai (1994)
10.1159/000050193
Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary
C. Bassi (2001)
10.1007/s11605-010-1212-0
Binding Versus Conventional Pancreaticojejunostomy After Pancreaticoduodenectomy: A Case-Matched Study
L. Maggiori (2010)
10.1186/1471-2482-7-3
Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct) OPeration (DROP-trial)
N. A. van der Gaag (2007)
10.1097/00000658-199305010-00002
One hundred and forty-five consecutive pancreaticoduodenectomies without mortality.
J. Cameron (1993)
10.1016/S0016-5085(97)70195-1
Evolution and current status of the Whipple procedure: an update for gastroenterologists.
S. Strasberg (1997)
10.1002/14651858.CD005444.pub3
Pre-operative biliary drainage for obstructive jaundice.
Yuan Fang (2012)
10.1097/00000658-200209000-00012
Pancreaticoduodenectomy With or Without Distal Gastrectomy and Extended Retroperitoneal Lymphadenectomy for Periampullary Adenocarcinoma, Part 2: Randomized Controlled Trial Evaluating Survival, Morbidity, and Mortality
C. Yeo (2002)
10.1001/archsurg.1995.01430030065013
Standards for pancreatic resection in the 1990s.
C. Fernández‐del Castillo (1995)
Prediction of pancreatic fistula by amylase levels of drainage fluid on the first day after pancreatectomy.
M. Yamaguchi (2003)
10.1016/j.ijsu.2008.04.007
Isolated roux loop pancreaticojejunostomy vs single loop pancreaticojejunostomy after pancreaticoduodenectomy.
L. Kaman (2008)
10.1007/s00534-011-0373-x
Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery
M. Kawai (2011)
Pancreatic juice output and amylase level in the drainage fluid after pancreatoduodenectomy in relation to leakage.
N. Hashimoto (2002)
10.1007/s00268-009-0220-2
How Do We Predict the Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy?—An Analysis in 244 Consecutive Patients
Manabu Kawai (2009)
10.1155/2009/404520
Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes
C. Schmidt (2009)
10.1097/01.sla.0000143248.71964.29
Pylorus Preserving Pancreaticoduodenectomy Versus Standard Whipple Procedure: A Prospective, Randomized, Multicenter Analysis of 170 Patients With Pancreatic and Periampullary Tumors
K. Tran (2004)
10.1016/S0002-9610(05)80151-5
Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management.
J. Cullen (1994)
10.1016/J.SURG.2005.08.012
Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients.
F. Muscari (2006)
10.1097/01.sla.0000246856.03918.9a
Assessment of Complications After Pancreatic Surgery: A Novel Grading System Applied to 633 Patients Undergoing Pancreaticoduodenectomy
M. Deoliveira (2006)
10.1016/J.SURG.2005.05.001
Postoperative pancreatic fistula: an international study group (ISGPF) definition.
C. Bassi (2005)
10.1016/S1091-255X(00)80074-8
Do preoperative biliary stents increase postpancreaticoduodenectomy complications?
T. Sohn (2000)
10.1007/s00268-001-0188-z
Duct-to-mucosa Pancreaticojejunostomy Reduces the Risk of Pancreatic Leakage after Pancreatoduodenectomy
M. D. Ryo Hosotani (2001)
10.1001/archsurg.1992.01420080079012
Complications following pancreaticoduodenectomy. Current management.
B. Miedema (1992)
anatomic and surgeon related factors
O Kollmar (2013)
10.1002/bjs.1800840843
Peritoneal seeding of pancreatic head carcinoma following percutaneous transhepatic drainage and stenting
J. Crinnion (1997)
10.1016/j.gassur.2004.09.044
Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula
J. W. Lin (2007)
10.1002/bjs.5407
Meta‐analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy
A. McKay (2006)
10.1097/00000658-199506000-00003
Optimal Management of the Pancreatic Remnant After Pancreaticoduodenectomy
S. Marcus (1995)
10.1097/00000658-200009000-00014
Does Prophylactic Octreotide Decrease the Rates of Pancreatic Fistula and Other Complications After Pancreaticoduodenectomy?: Results of a Prospective Randomized Placebo-Controlled Trial
C. Yeo (2000)
10.1007/s00268-003-6841-y
Does Drainage Fluid Amylase Reflect Pancreatic Leakage after Pancreaticoduodenectomy?
Y. Shyr (2003)
Safety and function of isolated Roux loop pancreaticojejunostomy after Whipple's pancreaticoduodenectomy.
Kingsnorth An (1994)
Complications following pancreaticoduodenectomy
BW Miedema (1992)
10.1097/01.sla.0000255588.50964.5d
Conventional Versus Binding Pancreaticojejunostomy After Pancreaticoduodenectomy: A Prospective Randomized Trial
Shu You Peng (2007)
10.1007/s00268-012-1460-0
Utility of Drain Fluid Amylase Measurement on the First Postoperative Day after Pancreaticoduodenectomy
R. Sutcliffe (2012)
10.1097/00000658-200003000-00001
Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis.
R. Jiménez (2000)
ESet al (2009)Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes
CM Schmidt (2009)
Is isolated Roux loop pancreaticojejunostomy superior to conventional reconstruction in pancreaticoduedenectomy? HPB (Oxf) 11:326–331
A Perwaiz (2009)
10.1097/00000658-199510000-00014
A Prospective Randomized Trial of Pancreaticogastrostomy Versus Pancreaticojejunostomy After Pancreaticoduodenectomy
C. Yeo (1995)
10.1097/SLA.0b013e3181e61e88
Early Versus Late Drain Removal After Standard Pancreatic Resections: Results of a Prospective Randomized Trial
C. Bassi (2010)
10.1097/01.sla.0000218077.14035.a6
Early Removal of Prophylactic Drains Reduces the Risk of Intra-abdominal Infections in Patients With Pancreatic Head Resection: Prospective Study for 104 Consecutive Patients
M. Kawai (2006)
10.1097/00000658-199908000-00001
Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy.
S. Povoski (1999)
10.3748/WJG.V16.I25.3178
Use of isolated Roux loop for pancreaticojejunostomy reconstruction after pancreaticoduodenectomy.
K. Ballas (2010)
One hundred and fortyfive consecutive pancreatico-duodenectomies without mortality
JL Cameron (1993)
10.1007/s00268-009-0179-z
Anatomy-Specific Pancreatic Stump Management to Reduce the Risk of Pancreatic Fistula After Pancreatic Head Resection
Yoshitsugu Tajima (2009)
10.1002/14651858.CD005444.pub2
Preoperative biliary drainage for obstructive jaundice.
Q. Wang (2008)
10.1097/SLA.0b013e3180caa42f
Amylase Value in Drains After Pancreatic Resection as Predictive Factor of Postoperative Pancreatic Fistula: Results of a Prospective Study in 137 Patients
E. Molinari (2007)
10.1007/s11605-007-0270-4
Pancreatic Anastomotic Leakage After Pancreaticoduodenectomy in 1,507 Patients: A Report from the Pancreatic Anastomotic Leak Study Group
K. Reid-Lombardo (2007)
10.1016/j.gassur.2005.08.029
The usefulness of drain data to identify a clinically relevant pancreatic anastomotic leak after pancreaticoduodenectomy?
H. Shinchi (2007)
10.1097/00000658-198801000-00009
The Complications of Pancreatectomy
M. Trede (1988)
10.1046/J.1365-2168.2000.01465.X
Pancreatic fistula after pancreatic head resection
M. Büchler (2000)
10.1097/00000658-199709000-00004
Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes.
C. Yeo (1997)



This paper is referenced by
10.1002/jso.25183
Impact of neoadjuvant therapy on postoperative outcomes after pancreaticoduodenectomy.
Katherine S Cools (2018)
10.1016/j.ijsu.2015.06.048
Can the measurement of amylase in drain after distal pancreatectomy predict post-operative pancreatic fistula?
R. Cirocchi (2015)
10.1016/S1499-3872(17)60051-1
Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases.
Ayman El Nakeeb (2017)
10.1016/j.hpb.2019.07.005
Early recognition of clinically relevant postoperative pancreatic fistula: a systematic review.
F. J. Smits (2019)
10.3748/wjg.v22.i34.7797
Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy
Bingyang Hu (2016)
10.1177/1457496917731188
The occurrence of Enterococcus faecium and faecalis Is significantly associated With anastomotic leakage After pancreaticoduodenectomy
M Belmouhand (2018)
10.1007/s00423-019-01830-w
Evaluation of preoperative risk factors for postpancreatectomy hemorrhage
Wataru Izumo (2019)
10.1016/j.pan.2017.07.003
Is pancreaticogastrostomy safer than pancreaticojejunostomy after pancreaticoduodenectomy? A meta-regression analysis of randomized clinical trials.
C. Ricci (2017)
10.1007/s11605-015-2795-2
Delayed Gastric Emptying After Pancreaticoduodenectomy. Risk Factors, Predictors of Severity and Outcome. A Single Center Experience of 588 Cases
Ayman El Nakeeb (2015)
10.4236/SS.2014.510069
A Simple and Dependable Technique for Pancreatic-Enteric Anastomosis with a Soft Pancreas and Nondilated Duct
Daniel V. Kostov (2014)
10.1007/s13304-014-0253-4
Pancreatico-duodenectomy and postoperative pancreatic fistula: risk factors and technical considerations in a specialized HPB center
Luciano De Carlis (2014)
10.1007/s11605-015-3030-x
A Cohort Study for Derivation and Validation of Early Detection of Pancreatic Fistula After Pancreaticoduodenectomy
K Takeishi (2015)
10.5772/60451
Current Concepts in Pancreatic Cancer
Z. Ramzan (2015)
10.1007/s00595-017-1509-7
Novel intraoperative use of the “Tensipresser” to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy
Manabu Mikamori (2017)
10.1016/j.ijsu.2014.01.017
Impact of obesity on surgical outcomes post-pancreaticoduodenectomy: a case-control study.
A. El Nakeeb (2014)
10.1007/s00268-018-4726-3
Hypophosphatemia as a Predictor of Organ-Specific Complications Following Gastrointestinal Surgery: Analysis of 8034 Patients
Eran Sadot (2018)
10.1016/j.hbpd.2018.08.004
Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: A retrospective study of 5-year survivors.
A. El Nakeeb (2018)
10.1089/pancan.2018.0008
Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality
Harish Lavu (2018)
10.14701/ahbps.2019.23.4.397
The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure
Vijayaraj Pavankumar (2019)
10.1007/s11605-014-2601-6
Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy
Christina W. Lee (2014)
10.1186/s12957-018-1365-y
Mesh-reinforced pancreaticojejunostomy versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: a retrospective study of 126 patients
Xin Zhong (2018)
10.3748/wjg.v25.i21.2650
Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy
Ye Li (2019)
10.1111/ans.15025
Significance of drain fluid amylase check on day 3 after pancreatectomy
S. R. Lee (2019)
Risk factors for complications after duodenopancreatectomy. Initial results after implementing a standardized perioperative protocol.
Adrian Bartoș (2014)
10.1159/000381032
Systematic Review and Meta-Analysis of Somatostatin Analogues in the Prevention of Postoperative Complication after Pancreaticoduodenectomy
K. Jin (2015)
10.1016/S1499-3872(16)60105-4
Outcomes of pancreaticoduodenectomy in elderly patients.
A. El Nakeeb (2016)
The Perioperative Outcomes of the Pancreaticoduodenectomy at Suratthani Hospital
Panitan Suemanothom (2016)
Progress in Study on Pancreatic Fistula after Pancreaticoduodenectomy
Bao-zhi Liu (2018)
Hemorrhagic Complications after Pancreatic Surgery: A Comprehensive Review of Literature
Muhammad Mohsin Ali (2019)
10.1007/s11605-013-2293-3
Postoperative Serum Amylase Predicts Pancreatic Fistula Formation Following Pancreaticoduodenectomy
J. Cloyd (2013)
10.1097/SLA.0000000000001038
Early Drain Removal--The Middle Ground Between the Drain Versus No Drain Debate in Patients Undergoing Pancreaticoduodenectomy: A Prospective Validation Study.
Zhi Ven Fong (2015)
10.3748/wjg.v19.i27.4596
Impact of being overweight on the surgical outcomes of patients with gastric cancer: a meta-analysis.
X. Wu (2013)
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