The impact of sarcopenia on the risk of postoperative pancreatic fistula after pancreatoduodenectomy (original) (raw)
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Evaluation of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy
INTRODUCTION Pa n c r e a t i c f i s t u l a (P F) r e m a i n s t h e m o s t common and challenging complication following pancreaticoduodenectomy (PD), with an incidence of 2%-28%. [1] A soft pancreas is the most consistent risk factor for postoperative pancreatic fistula (POPF) following PD. In addition to organ consistency, other potential risk factors include pancreatic duct size, body mass index (BMI), diabetes mellitus (DM), and preoperative elevated serum bilirubin. The mortality rate following PD is <5%, while Background: Pancreatic fistula (PF) remains the most common and challenging complication following pancreaticoduodenectomy (PD), with an incidence of 2%-28%. The primary objective of this study was to assess the correlation of fatty infiltration and fibrosis of the pancreas with postoperative pancreatic fistula (POPF). Secondary objectives were to investigate the correlations of POPF with the main pancreatic duct size and subjective intraoperative assessment of pancreatic texture and to determine if diabetes mellitus (DM), body mass index, or increased serum bilirubin correlate with POPF. Materials and Methods: This prospective study was performed at Sudhamayi Hospital, Kochi, India. Forty-six patients were included and divided into either the fatty infiltration group (n = 20) or fibrosis group (n = 17); nine patients had neither fatty nor fibrotic glands. Data were analyzed using analysis of variance and Chi-square test, utilizing SPSS software version 20 (IBM Inc., Armonk, NY, USA). Results: Patients with fatty pancreas had a ten times higher incidence of PF than those with fibrotic pancreas (odds ratio, 10.8; 95% confidence interval [CI], 2.2-52.4; P = 0.003). POPF was 7.9 times higher in patients with a nondilated duct compared to patients with a dilated duct (95% CI, 2.118-29.5; P = 0.003). Preoperative elevated serum bilirubin, body mass index, and DM were not found to be significant risk factors for POPF. Conclusion: We demonstrated that fatty pancreas and small pancreatic duct size (≤3 mm) are risk factors for POPF. Preoperative elevated serum bilirubin, body mass index, and DM were not found to be significant risk factors.
World Journal of Gastroenterology, 2008
Pancreatic resection is the standard treatment for pancreatic malignancy and certain benign pancreatic disorders. However, pancreatic resection is technically a demanding procedure. At diagnosis, more than 85% of pancreatic tumors are at an advanced stage. Thus, potentially curative resections are possible only in 10%-15% patients [1,2] . The standard surgical procedure for a lesion in the pancreatic head is pancreaticoduodenectomy (PD), while distal pancreatectomy (DP) with or without splenectomy, is performed for tumors in the body and tail.
Body mass index is a risk factor of pancreatic fistula after pancreaticoduodenectomy
The American surgeon, 2012
Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a severe complication and a challenging problem. The common risk factors are the soft pancreas and small pancreatic duct of the remnant pancreas. Those two risk factors were recognized during surgery. On the other hand, a preoperatively determined risk factor of PF is unclarified. We conducted a retrospective analysis of 203 patients consecutively treated by PD from April 2000 to October 2010. PF was defined according to the criteria of the International Study Group of Pancreatic Fistula. Clinical and pre- and intraoperative data were compared between PF and non-PF patients. The recommended cutoff value of body mass index (BMI) as 20 kg/m(2) was defined by receiver operating characteristic curve analysis. PF occurred in 53 (26.1%) of 203 patients. In univariate analysis, BMI and soft remnant pancreas were found to be risk factors of PF (P = 0.027, P = 0.005). In multivariate analysis, BMI and soft pancreas were also...
European Journal of Therapeutics
Objective: Postoperative pancreatic fistula (POPF) affects 13-50% of patients undergoing pancreaticoduodenectomy (PD), and remains the main source of post-PD morbidity and mortality. Therefore, determining predictive risk factors for POPF remains popular today. In this study, we aimed to determine the predictive risk factors for clinically related postoperative pancreatic fistula (CR-POPF) in the preoperative and early postoperative period in patients that underwent PD. Methods: This is a retrospective study involving 248 patients who underwent PD between January 2015 and December 2019 in our center. We compared the groups that did and did not develop CR-POPF. We determined the risk factors affecting CR-POPF by stepwise logistic regression analysis. Results: 141 (56.8%) of the patients included in the study were male and the median age was 63 (56-70)/year. The CR-POPF rate was 18.1%. We found a statistically significant difference (p <0.05) in the following parameters: diabetes, ...
The American Journal of Surgery, 2009
BACKGROUND: Pancreatic fistula (PF) is one of the most common postoperative complications of pancreatoduodenectomy (PD). A recent International Study Group on Pancreatic Fistula (ISGPF) definition grades the severity of PF according to the clinical impact on the patient's hospital course. Although PF is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or may be life-threatening and necessitate emergency reoperation (grade C). The aim of the present study was to evaluate the incidence of postoperative grade C PF after PD and to assess the prognosis and risk factors for this life-threatening condition. STUDY DESIGN: Between January 2000 and December 2006, 680 consecutive patients underwent PD in 5 digestive surgery departments in the northwest region of France (Lille, Amiens, Rouen, and Caen). PF was defined as drain output of any measurable volume of fluid on or after postoperative day 3 with amylase content greater than 3 times the serum amylase activity (ISGPF guidelines). To identify possible risk factors for grade C PF, we reviewed the records of 111 (16.3%) patients with postoperative PF and compared grade C cases with grade AϩB cases. RESULTS: The median age was 59 years (range 22-87). The male-to-female ratio was 1.6:1. Fifty-six (50.4%) PDs were performed via pancreaticogastrostomy and 55 via pancreaticojejunostomy. Overall mortality was 2% (n ϭ 14). Grade C PF was observed in 36 (32%) patients, of whom 17 (47%)
Journal of Contemporary Medical Sciences, 2020
Objective: This study aimed to investigate the effect of sarcopenia on the development of serious postoperative complications in patients who underwent curative pancreatectomy for pancreatic cancer. Methods: Total psoas index (TPI) was calculated for sarcopenia diagnosis by measures of psoas muscle area on the level of L3 spine from preoperative staging computerised tomograhpy (CT) images in pancreatic cancer patients undergoing curative resection. Patient demographics and postoperative outcomes were analised in sarcopenic and non-sarcopenic group. Results: It has been found to be statistically significant relation between severe postoperative complication and sarcopenia (p=0,001>). Sarcopenia was more associated with cardiac and pulmoner complications among others (p=0.007, p=0.003 respectively). In multivariate analysis, age (OR: 1,08. %95 CI: 1,01~1,15, p=0,013), ASA score (OR: 2,84. 95% CI 1,62 ~ 4,97. p= 0,043) and TPI (OR: 3,61. 95% CI: 1,58 ~ 5,74. p= 0,001>) has been ...
Background Most complications after pancreatoduodenectomy (PD) are due to pancreatic fistula (PF). Therefore, predicting PF is important to individualize treatment. The aim of this study is to develop a preoperative nomogram to predict PF after PD. Methods From January 2009 to January 2018, patients that underwent PD were reviewed. After univariate analyses, variables with p < 0.1 were selected for a multivariate analysis. Variables with p < 0.05 were then included in the nomogram, which was internally validated in a different set of patients. Results Out of 180 patients evaluated, 19.4% experienced PF. Risk factors for PF were male gender (OR = 2.89), higher BMI (OR = 1.14) and pancreatic duct diameter ≤ 3 mm (OR = 3.52). Weight loss greater than 10% was protective against PF (OR = 0.16). Using these four variables, a preoperative nomogram was built. The nomogram performed well in the validation set (n = 82 patients, 25.6% with PF) with an area under the ROC curve of 0.798. C...
Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy
World Journal of Gastroenterology, 2008
AIM: To analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS: We r e t r o s p e c t i v e l y r e v i e w e d 1 7 2 consecutive patients who had undergone pancreaticoduodenectomy at Inha University Hospital between April 1996 and March 2006. We analyzed the pancreatic fistula rate according to the clinical characteristics, the pathologic and laboratory findings, and the anastomotic methods. RESULTS: The incidence of developing pancreatic fistulas in patients older than 60 years of age was 21.7% (25/115), while the incidence was 8.8% (5/57) for younger patients; the difference was significant (P = 0.03). Patients with a dilated pancreatic duct had a lower rate of post-operative pancreatic fistulas than patients with a non-dilated duct (P = 0.001). Other factors, including clinical features, anastomotic methods, and pathologic diagnosis, did not show any statistical difference. CONCLUSION: O u r s t u d y d e m o n s t ra t e d t h a t pancreatic fistulas are related to age and a dilated pancreatic duct. The surgeon must take these risk factors into consideration when performing a pancreaticoduodenectomy.
Journal of Surgery and Medicine, 2020
with the decision number 54/D, dated 2/10/2009. All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Bu çalışma SB İstanbul Göztepe Eğitim ve Araştırma Hastanesi Etik Kurulu tarafından 10.02.2009 tarihli 54/D karar numaralı ile onaylanmıştır. İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.
Scoring System to Predict Pancreatic Fistula After Pancreaticoduodenectomy
Annals of Surgery, 2015
Objective: To validate a preoperative predictive score of postoperative pancreatic fistula (POPF). Other risk factors for POPF were sought in an attempt to improve the score. Background: POPF is the major contributor to morbidity after pancreaticoduodenectomy (PD). A preoperative score [using body mass index (BMI) and pancreatic duct width] to predict POPF was tested upon a multicenter patient cohort to assess its performance. Methods: Patients undergoing PD at 8 UK centers were identified. The association between the score and other pre-, intra-, and postoperative variables with POPF was assessed. Results: A total of 630 patients underwent PD with 141 occurrences of POPF (22.4%). BMI, perirenal fat thickness, pancreatic duct width on computed tomography and at operation, bilirubin, pancreatojejunostomy technique, underlying pathology, T stage, N stage, R status, and gland firmness were all significantly associated with POPF. The score predicted POPF (P < 0.001) with a higher predictive score associated with increasing severity of POPF (P < 0.001). Stepwise multivariate analysis of pre-, intra-, and postoperative variables demonstrated that only the score was consistently associated with POPF. A table correlating the risk score to actual risk of POPF was created. Conclusions: The predictive score performed well and could not be improved. This provides opportunities for individualizing patient consent and selection, and treatment and research applications.