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Predictors and Outcomes of Pancreatic Fistula Following Pancreaticoduodenectomy: a Dual Center Experience

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Abstract

Fistula following leaked pancreatico-enteric anastomosis is a common, potentially lethal complication of pancreaticoduodenectomy (PD). Early assessment and prediction of its occurrence can improve postoperative outcomes. Various perioperative factors were analyzed for its contribution to clinically relevant postoperative pancreatic fistula (crPOPF). Also, the difference in clinical outcomes of patients with and without fistula was studied. Sixty-seven patients undergoing PD for malignancies were analyzed during 3-year period in a dual-institutional study. Various preoperative, intraoperative, and postoperative factors were assessed. The incidence and severity of POPF and its association with the development of other post-PD complications were observed. Patients with and without POPF were divided into groups and compared with univariate and multivariate analyses, to identify significant contributing factors. Clinically relevant POPF was present in 20.9% cases. crPOPF contributed to delayed gastric emptying, albeit insignificant (p = 0.403), but was significantly associated with increased incidence of post-pancreatectomy hemorrhagic (p = 0.005) and infectious complications (p = 0.013). Soft pancreas (p = 0.024), intraoperative blood loss (p = 0.045), blood transfusion (p = 0.024), and fistula risk score (p = 0.001) were significant predictors of crPOPF. First postoperative day (POD1) drain fluid amylase (DFA) values at cut-off of 1336 U/L (AUC = 0.871; p < 0.001) significantly predicted crPOPF with good sensitivity and specificity. POD1 DFA was only factor significant on multivariate analysis (p = 0.014). There was no significant difference in overall survival between groups. crPOPF results in significant post-pancreatectomy hemorrhagic and septic complications, along with increased mortality. It can be accurately predicted by several preoperative and intraoperative factors. POD1 DFA can independently predict crPOPF development.

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Data Availability

Masterchart/excel spreadsheet of study subjects will be available on request.

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Acknowledgments

We express our gratitude to Mr. Manoj Pandey (M/S Research Solutions, Lucknow) for the support in statistical analysis and final formatting of the article.

Funding

No funding or financial support obtained during study or manuscript preparation.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India

    Suneed Kumar, Shibumon M. Madhavan, Dinesh Kumar, Smita Chauhan, Anshuman Pandey & Shakeel Masood

  2. Department of Surgical Gastroenterology, King George Medical University, Lucknow, Uttar Pradesh, India

    Abhijit Chandra

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  1. Suneed Kumar
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  2. Abhijit Chandra
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  7. Shakeel Masood
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Contributions

All authors contributed to the study conception and design, but was headed by Shakeel Masood and Abhijit Chandra. Material preparation, data collection, and analysis were performed by Suneed Kumar, Shibumon M. Madhavan, and Dinesh Kumar. The first draft of the manuscript was written by Suneed Kumar, and all authors commented on previous versions of the manuscript. The manuscript was critically revised and edited by Anshuman Pandey, Smita Chauhan, and Abhijit Chandra. All authors read and approved the final manuscript. Overall supervision of the study was by Shakeel Masood.

Corresponding author

Correspondence to Shakeel Masood.

Ethics declarations

The study obtained clearance for Institutional Ethics Committee with ref. # IEC 38/17. Informed written consent for treatment, use of clinical details and publication of data was obtained from all the subjects of the study.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

The study obtained clearance for Institutional Ethics Committee with ref. # IEC 38/17.

Informed Consent

Informed written consent for treatment, use of clinical details and publication of data was obtained from all the subjects of the study.

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Kumar, S., Chandra, A., Madhavan, S.M. et al. Predictors and Outcomes of Pancreatic Fistula Following Pancreaticoduodenectomy: a Dual Center Experience. Indian J Surg Oncol 12, 22–30 (2021). https://doi.org/10.1007/s13193-020-01195-3

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  • DOI: https://doi.org/10.1007/s13193-020-01195-3

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