Analysis of Related Risk Factors for Pancreatic Fistula Following Pancreaticoduodenec-tomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DUNing ,  GUOWei-dong , WULi-qun , ZOUHao , SUNPeng , SHIZhen , TANGHai-tao

Department of Hepatobiliary Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China;

Corresponding author：

GUOWei-dong, Email: gwdrk@126.com

Keywords：

Pancreaticoduodenectomy; Pancreatic fistula; Risk factor

DOI：

10.7507/1007-9424.20150251

Video：

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Objective To analyze the risk factors for pancreatic fistula following pancreaticoduodenectomy. Method The clinical data of 150 patients underwent pancreaticoduodenectomy in this hospital from January 2011 to January 2014 were reviewed, and the potential factors for pancreatic fistular were evaluated by both univariate and multivariate analysis. Results The incidence of pancreatic fistula was 12.7% (19/150). Univariate analysis results showed that the age, preoperative high bilirubin level, texture of the remnant pancreas, diameter of wirsung, operative time were associated with pancreatic fistula following pancreaticoduodenectomy (P < 0.05). Multivariate logistic regression analysis results revealed that the texture of the remnant pancreas, diameter of wirsung, and operative time were the inde-pendent risk factors (P < 0.05) for pancreatic fistula following pancreaticoduodenectomy. Conclusions Texture of the remnant pancreas, diameter of wirsung, operative time are independent risk factors for pancreatic fistula following pancreaticoduodenectomy. Rich experience and skilled surgical procedures could effectively reduce the incidence of pancreatic fistula.

Citation： DUNing, GUOWei-dong, WULi-qun, ZOUHao, SUNPeng, SHIZhen, TANGHai-tao. Analysis of Related Risk Factors for Pancreatic Fistula Following Pancreaticoduodenec-tomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(8): 967-971. doi: 10.7507/1007-9424.20150251 Copy

1.	黄鹤, 王春友, 吴佩, 等.三种胰肠吻合方式下两类胰漏的探讨.实用医学杂志, 2005, 21(22):2498-2500.
2.	Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications, and outcomes. Ann Surg, 1997, 226(3):248-260.
3.	Suzuki Y, Fujino Y, Tanioka Y, et al. Selection of pancreaticojejunos-tomy techniques according to pancreatic texture and duct size. Arch Surg, 2002, 137(9):1044-1048.
4.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
5.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) defination. Surgrey, 2005, 138(1):8-13.
6.	Pedrazzoli S, Liessi G, Pasquali C, et al. Postoperative pancreatic fistulas:preventing severe complications and reducing reoperation and mortality rate. Ann Surg, 2009, 249(1):97-104.
7.	田孝东, 杨尹默, 庄岩, 等.胰十二指肠切除术后胰瘘的危险因素分析.中华肝胆外科杂志, 2005, 11(6):390-393.
8.	Matsusue S, Takeda H, Nakamura Y, et al. A prospective analysis of the factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies. Surg Today, 1998, 28(7):719-726.
9.	Choe YM, Lee KY, Oh CA, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol, 2008, 14(45):6970-6974.
10.	El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience). World J Surg, 2013, 37(6):1405-1418.
11.	Cogbill TH, Moore EE, Morris JA, et al. Distal pancreatectomy for trauma:a multicenter experience. J Trauma, 1991, 31(12):1600-1606.
12.	Martignoni ME, Wagner M, Krähenbühl L, et al. Effect of preopera-tive biliary drainage on surgical outcome after pancreatoduodenec-tomy. Am J Surg, 2001, 181(1):52-59.
13.	Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg, 2004, 8(8):951-959.
14.	Mathur A, Pitt HA, Marine M, et al. Fatty pancreas:a factor in postoperative pancreatic fistula. Ann Surg, 2007, 246(6):1058-1064.
15.	Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1):1-14.
16.	Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for develo-pment of pancreatic fistula using the ISGPF classification scheme. World J Surg, 2008, 32(3):419-428.
17.	Wellner UF, Kayser G, Lapshyn H, et al. A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB (Oxford), 2010, 12(10):696-702.
18.	Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy:multiva-riate analysis in 300 patients. Surgery, 2006, 139(5):591-598.
19.	De Castro SM, Busch OC, Van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg, 2005, 92(9):1117-1123.
20.	Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg, 1995, 222(4):580-592.
21.	袁伟升, 刘鹏, 陈键锋, 等.保留幽门的胰十二指肠切除术37例疗效分析.中国普外基础与临床杂志, 2012, 19(6):665-667.
22.	顾钧, 吴文广, 丁琦晨, 等.胰十二指肠切除术后出血的危险因素及其诊治.中国普外基础与临床杂志, 2012, 19(6):653-656.
23.	Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg, 2002, 235(6):803-813.
24.	Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection:toward the end of completion pancreatec-tomy. Arch Surg, 2003, 138(12):1310-1315.
25.	Akamatsu N, Sugawara Y, Komagome M, et al. Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy:the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. J Hepatobiliary Pancreat Sci, 2010, 17(3):322-328.
26.	吴明蓬, 张笑, 刘曦娇, 等.术前CT测量的胰管直径和胰腺厚度对胰十二指肠切除术后胰瘘的预测价值.中国普外基础与临床杂志, 2014, 21(8):1019-1023.
27.	Gouma DJ, Van Geenen RC, Van Gulik TM, et al. Rates of comp-lications and death after pancreaticoduodenectomy:risk factors and the impact of hospital volume. Ann Surg, 2000, 232(6):786-795.

1. 黄鹤, 王春友, 吴佩, 等.三种胰肠吻合方式下两类胰漏的探讨.实用医学杂志, 2005, 21(22):2498-2500.
2. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications, and outcomes. Ann Surg, 1997, 226(3):248-260.
3. Suzuki Y, Fujino Y, Tanioka Y, et al. Selection of pancreaticojejunos-tomy techniques according to pancreatic texture and duct size. Arch Surg, 2002, 137(9):1044-1048.
4. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
5. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) defination. Surgrey, 2005, 138(1):8-13.
6. Pedrazzoli S, Liessi G, Pasquali C, et al. Postoperative pancreatic fistulas:preventing severe complications and reducing reoperation and mortality rate. Ann Surg, 2009, 249(1):97-104.
7. 田孝东, 杨尹默, 庄岩, 等.胰十二指肠切除术后胰瘘的危险因素分析.中华肝胆外科杂志, 2005, 11(6):390-393.
8. Matsusue S, Takeda H, Nakamura Y, et al. A prospective analysis of the factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies. Surg Today, 1998, 28(7):719-726.
9. Choe YM, Lee KY, Oh CA, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol, 2008, 14(45):6970-6974.
10. El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience). World J Surg, 2013, 37(6):1405-1418.
11. Cogbill TH, Moore EE, Morris JA, et al. Distal pancreatectomy for trauma:a multicenter experience. J Trauma, 1991, 31(12):1600-1606.
12. Martignoni ME, Wagner M, Krähenbühl L, et al. Effect of preopera-tive biliary drainage on surgical outcome after pancreatoduodenec-tomy. Am J Surg, 2001, 181(1):52-59.
13. Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg, 2004, 8(8):951-959.
14. Mathur A, Pitt HA, Marine M, et al. Fatty pancreas:a factor in postoperative pancreatic fistula. Ann Surg, 2007, 246(6):1058-1064.
15. Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1):1-14.
16. Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for develo-pment of pancreatic fistula using the ISGPF classification scheme. World J Surg, 2008, 32(3):419-428.
17. Wellner UF, Kayser G, Lapshyn H, et al. A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB (Oxford), 2010, 12(10):696-702.
18. Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy:multiva-riate analysis in 300 patients. Surgery, 2006, 139(5):591-598.
19. De Castro SM, Busch OC, Van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg, 2005, 92(9):1117-1123.
20. Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg, 1995, 222(4):580-592.
21. 袁伟升, 刘鹏, 陈键锋, 等.保留幽门的胰十二指肠切除术37例疗效分析.中国普外基础与临床杂志, 2012, 19(6):665-667.
22. 顾钧, 吴文广, 丁琦晨, 等.胰十二指肠切除术后出血的危险因素及其诊治.中国普外基础与临床杂志, 2012, 19(6):653-656.
23. Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg, 2002, 235(6):803-813.
24. Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection:toward the end of completion pancreatec-tomy. Arch Surg, 2003, 138(12):1310-1315.
25. Akamatsu N, Sugawara Y, Komagome M, et al. Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy:the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. J Hepatobiliary Pancreat Sci, 2010, 17(3):322-328.
26. 吴明蓬, 张笑, 刘曦娇, 等.术前CT测量的胰管直径和胰腺厚度对胰十二指肠切除术后胰瘘的预测价值.中国普外基础与临床杂志, 2014, 21(8):1019-1023.
27. Gouma DJ, Van Geenen RC, Van Gulik TM, et al. Rates of comp-lications and death after pancreaticoduodenectomy:risk factors and the impact of hospital volume. Ann Surg, 2000, 232(6):786-795.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Related Risk Factors for Pancreatic Fistula Following Pancreaticoduodenec-tomy

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