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A Comparative Analysis of Postoperative Pancreatic Fistulas After Surgery With and Without Hyperthermic Intraperitoneal Chemoperfusion

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postoperative pancreatic fistulas (POPFs) are potentially morbid complications that often require therapeutic interventions. Distal pancreatectomy performed during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) puts patients at risk for POPF. The authors hypothesized that POPFs are more severe after CRS/HIPEC than after pancreatectomy alone.

Methods

Clinicopathologic and perioperative details, including POPF by International Study Group of Pancreatic Fistula criteria (ISGPF), and oncologic outcomes for patients undergoing distal pancreatectomy during CRS/HIPEC for peritoneal carcinomatosis of appendiceal (n = 31) or colorectal (n = 23) origin (HIPEC group) were compared with those for patients undergoing minimally invasive or open distal pancreatectomy without HIPEC (n = 66) for locally resectable pancreatic adenocarcinoma (non-HIPEC group).

Results

The incidence of POPF was similar between the HIPEC and non-HIPEC groups (26 %). The severity of POPF according to the ISGPF criteria was significantly worse in the HIPEC group. The HIPEC patients had 13 grade B fistulas and 1 grade C fistula compared with 12 grade A fistulas and 4 grade B fistulas in the non-HIPEC group. The HIPEC patients with POPF did not differ in the extent of their CRS, peritoneal cancer index, length of hospital stay, or other postoperative complications from the the HIPEC patients without POPF. The HIPEC patients with colorectal carcinomatosis who experienced POPF had higher disease recurrence in the first year after CRS/HIPEC than those without POPF.

Conclusion

The findings showed that POPFs are more severe when distal pancreatectomy is combined with CRS/HIPEC. Moreover, selective use of distal pancreatectomy is important during CRS/HIPEC because POPFs may increase early disease recurrence for patients with colorectal carcinomatosis.

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Acknowledgement

S. Downs-Canner and D. Magge were supported by grant T32CA113263 from the National Cancer Institute. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA

    Stephanie Downs-Canner MD, Deepa R. Magge MD, Heather Jones MPA-C, Lekshmi Ramalingam MD, Amer Zureikat MD, Matthew Holtzman MD, Steven Ahrendt MD, James Pingpank MD, Herbert J. Zeh MD, David L. Bartlett MD & Haroon A. Choudry MD

  2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    Ying Ding PhD

Authors
  1. Stephanie Downs-Canner MD
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  2. Ying Ding PhD
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  3. Deepa R. Magge MD
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  4. Heather Jones MPA-C
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  5. Lekshmi Ramalingam MD
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  6. Amer Zureikat MD
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  12. Haroon A. Choudry MD
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Correspondence to Haroon A. Choudry MD.

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Downs-Canner, S., Ding, Y., Magge, D.R. et al. A Comparative Analysis of Postoperative Pancreatic Fistulas After Surgery With and Without Hyperthermic Intraperitoneal Chemoperfusion. Ann Surg Oncol 22, 1651–1657 (2015). https://doi.org/10.1245/s10434-014-4186-4

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  • DOI: https://doi.org/10.1245/s10434-014-4186-4

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