TITLE

A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients

AUTHOR(S)
Daskalaki, Despoina; Butturini, Giovanni; Molinari, Enrico; Crippa, Stefano; Pederzoli, Paolo; Bassi, Claudio
PUB. DATE
January 2011
SOURCE
Langenbeck's Archives of Surgery;Jan2011, Vol. 396 Issue 1, p91
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
im: Postoperative pancreatic fistula (POPF) has a wide range of clinical and economical implications due to the difference of the associated complications and management. The aim of this study is to verify the applicability of the International Study Group of Pancreatic Fistula (ISGPF) definition and its capability to predict hospital costs. Methods: This is a retrospective study based on prospectively collected data of 755 patients who underwent pancreaticoduodenectomy in our institution between November 1996 and October 2006. A number of 147 patients (19.5%) have developed a POPF according to ISGPF definition. Results: Grade A fistula, which has no clinical impact, occurred in 19% of all cases. Grade B occurred in 70.7% and was successfully managed with conservative therapy or mini-invasive procedures. Grade C (8.8%) was associated to severe clinical complications and required invasive therapy. Pulmonary complications were statistically higher in the groups B and C rather than the group A POPFs ( p < 0.005; OR 8). Patients with carcinoma of the ampullary region had a higher incidence of POPF compared to ductal cancer, with a predominance of grade A ( p = 0.036). Increasing fistula grades have higher hospital costs (€11.654, €25.698, and €59.492 for grades A, B, and C, respectively; p < 0.001). Conclusions: The development of a POPF does not always determine a substantial change of the postoperative management. Clinically relevant fistulas can be treated conservatively in most cases. Higher fistula severity corresponds to increased costs. The grading system proposed by the ISGPF allows a correct stratification of the complicated patients based on the real clinical and economic impact of the POPF.
ACCESSION #
56525545

 

Related Articles

  • Pancreatic resectional surgery: An evidence-based perspective. D'souza, Melroy A.; Shrikhande, Shailesh V. // Journal of Cancer Research & Therapeutics;Apr-Jun2008, Vol. 4 Issue 2, p77 

    A diagnosis of pancreatic cancer carries a very dismal prognosis, with the 5-year survival rate being the lowest of all types of cancer. Surgical resection offers the only hope for cure in these patients. Pancreatic resectional surgery is technically demanding, and while mortality has decreased...

  • Pancreatic Fistula after Pancreatectomy: Definitions, Risk Factors, Preventive Measures, and Management--Review. Machado, Norman Oneil // International Journal of Surgical Oncology;2012, p1 

    Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic...

  • Management of Persistent Pancreatic Fistula after Pancreatoduodenectomy. Rebibo, Lionel; Yzet, Clara; Yzet, Thierry; Delcenserie, Richard; Bartoli, Eric; Regimbeau, Jean-Marc // American Surgeon;Nov2014, Vol. 80 Issue 11, pE281 

    The article discusses a research on pancreatoduodenectomy (PD). It references several studies including "Treatment of Cancer of the Exocrinepancreas" by M. Huguier and N. P. Mason and published in a 1999 issue of the "American Journal of Surgery" and "Pancreatogastrostomy as a Salvage Procedure...

  • Sentinel bleeding after pancreaticoduodenectomy: a disregarded sign. Treckmann, Jürgen; Paul, Andreas; Sotiropoulos, Georgios C.; Lang, Hauke; Özcelik, Arzu; Saner, Fuat; Broelsch, Christoph E.; Treckmann, Jürgen; Ozcelik, Arzu // Journal of Gastrointestinal Surgery;Feb2008, Vol. 12 Issue 2, p313 

    Introduction: Delayed massive hemorrhage induced by pancreatic fistula after pancreaticoduodenectomy is a rare but life-threatening complication. The purpose of this study was to analyze the clinical course of patients with late hemorrhage, with or without sentinel bleeding, to...

  • A new simple and safe technique of end-to-end invaginated pancreaticojejunostomy with transpancreatic U-sutures—early postoperative outcomes in consecutive 88 cases. Xiao-Ping Chen; Fa-Zu Qiu; Zhi-Wei Zhang; Yi-Fa Chen; Zhi-Yong Huang; Wan-Guang Zhang // Langenbeck's Archives of Surgery;Sep2009, Vol. 394 Issue 4, p739 

    Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Thus, a number of technical modifications regarding the pancreato-enteric anastomosis after PD have been proposed to reduce POPF rate. Until now, there is no consensus...

  • Pancreaticogastrostomy after pancreaticoduodenectomy without suturing the pancreas. Halkic, Nermin; Kobayashi, Kosuke; Kokudo, Takashi; Di Mare, Luca; Yamaguchi, Takamune; Kudo, Hiroki; Demartines, Nicolas; Uldry, Emilie // Surgery Today;Feb2020, Vol. 50 Issue 2, p200 

    The aim of the present paper was to describe a new and easy technique for performing pancreaticogastrostomy (PG) through simple pancreatic invagination by a single binding suture without suturing the pancreatic parenchyma. The present study included all consecutive patients who underwent...

  • Pancreatic fistula after pancreatectomy: Evolving definitions, preventive strategies and modern management. Shrikhande, Shailesh V.; D'Souza, Melroy A.; Llado, Laura // World Journal of Gastroenterology;10/14/2008, Vol. 14 Issue 38, p5789 

    Pancreatic resection is the treatment of choice for pancreatic malignancy and certain benign pancreatic disorders. However, pancreatic resection is technically a demanding procedure and whereas mortality after a pancreaticoduodenectomy is currently < 3%-5% in experienced high-volume centers,...

  • 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. Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Komagome, Masahiko; Shin, Nobuhiro; Cho, Narihiro; Ishida, Takashi; Ozawa, Fumiaki; Hashimoto, Daijo // Journal of Hepato -- Biliary -- Pancreatic Sciences;May2010, Vol. 17 Issue 3, p322 

    Objective: Postoperative pancreatic fistula (POPF) is a severe and frequent complication after pancreaticoduodenectomy (PD). The aim of this study was to identify an independent predictor of POPF and to assess the efficacy of preoperative multidetector row computed tomography (MDCT) images as an...

  • Systematic Review and Meta-analysis of Enhanced Recovery After Pancreatic Surgery with Particular Emphasis on Pancreaticoduodenectomies. Coolsen, M.; Dam, R.; Wilt, A.; Slim, K.; Lassen, K.; Dejong, C. // World Journal of Surgery;Aug2013, Vol. 37 Issue 8, p1909 

    Background: In the past decade, Enhanced Recovery after Surgery (ERAS) protocols have been implemented in several fields of surgery. With these protocols, a faster recovery and shorter hospital stay can be accomplished without an increase in morbidity or mortality. The purpose of this study was...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics