Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy: Analysis of 2026 Resections From the International, Multi-institutional Distal Pancreatectomy Study Group.
In: Annals of surgery, Jg. 269 (2019), Heft 1, S. 143-149
Online
academicJournal
Zugriff:
Objective: To identify a clinical fistula risk score following distal pancreatectomy.
Background: Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to reduce its occurrence remain elusive.
Methods: This multinational, retrospective study of 2026 DPs involved 52 surgeons at 10 institutions (2001-2016). CR-POPFs were defined by 2016 International Study Group criteria, and risk models generated using stepwise logistic regression analysis were evaluated by c-statistic. Mitigation strategies were assessed by regression modeling while controlling for identified risk factors and treating institution.
Results: CR-POPF occurred following 306 (15.1%) DPs. Risk factors independently associated with CR-POPF included: age (<60 yrs: OR 1.42, 95% CI 1.05-1.82), obesity (OR 1.54, 95% CI 1.19-2.12), hypoalbuminenia (OR 1.63, 95% CI 1.06-2.51), the absence of epidural anesthesia (OR 1.59, 95% CI 1.17-2.16), neuroendocrine or nonmalignant pathology (OR 1.56, 95% CI 1.18-2.06), concomitant splenectomy (OR 1.99, 95% CI 1.25-3.17), and vascular resection (OR 2.29, 95% CI 1.25-3.17). After adjusting for inherent risk between cases by multivariable regression, the following were not independently associated with CR-POPF: method of transection, suture ligation of the pancreatic duct, staple size, the use of staple line reinforcement, tissue patches, biologic sealants, or prophylactic octreotide. Intraoperative drainage was associated with a greater fistula rate (OR 2.09, 95% CI 1.51-3.78) but reduced fistula severity (P < 0.001).
Conclusions: From this large analysis of pancreatic fistula following DP, CR-POPF occurrence cannot be reliably predicted. Opportunities for developing a risk score model are limited for performing risk-adjusted analyses of mitigation strategies and surgeon performance.
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Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy: Analysis of 2026 Resections From the International, Multi-institutional Distal Pancreatectomy Study Group.
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Autor/in / Beteiligte Person: | Ecker, BL ; McMillan, MT ; Allegrini, V ; Bassi, C ; Beane, JD ; Beckman, RM ; Behrman, SW ; Dickson, EJ ; Callery, MP ; Christein, JD ; Drebin, JA ; Hollis, RH ; House, MG ; Jamieson, NB ; Javed, AA ; Kent, TS ; Kluger, MD ; Kowalsky, SJ ; Maggino, L ; Malleo, G ; Valero V 3rd ; Velu, LKP ; Watkins, AA ; Wolfgang, CL ; Zureikat, AH ; Vollmer CM Jr |
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Zeitschrift: | Annals of surgery, Jg. 269 (2019), Heft 1, S. 143-149 |
Veröffentlichung: | Philadelphia, PA : Lippincott Williams & Wilkins, 2019 |
Medientyp: | academicJournal |
ISSN: | 1528-1140 (electronic) |
DOI: | 10.1097/SLA.0000000000002491 |
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