Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Fachpsychotherapie Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
World Journal of Surgery
Erschienen in:

31.03.2021 | Original Scientific Report

Clinical Impact of Portal Vein Distance on Computed Tomography for Postoperative Pancreatic Fistula after Pancreatoduodenectomy

verfasst von: Yutaka Endo, Minoru Kitago, Masahiro Shinoda, Hiroshi Yagi, Yuta Abe, Go Oshima, Shutaro Hori, Takahiro Yokose, Kodai Abe, Ryo Takemura, Ryota Ishi, Yuko Kitagawa

Erschienen in: World Journal of Surgery | Ausgabe 7/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Pancreatic fistulas remain a significant concern after pancreatectomy owing to the associated high risk of mortality and high costs. It is not possible to perform preoperative risk stratification for all patients. This study aimed to evaluate the usefulness of the measurement of portal vein (PV) distance as a predictive indicator of pancreatic fistula development after pancreatoduodenectomy and compare it with the usefulness of other indicators such as body mass index (BMI), and abdominal fat area.

Methods

Patient characteristics, preoperative laboratory data, radiographic findings, and their association with pancreatic fistula development after pancreatoduodenectomy were analyzed for 157 patients who underwent resection during 2011–2017. Clinically relevant postoperative pancreatic fistulas (CR-POPF) were defined as Grade B or C fistulas based on the International Study Group of Pancreatic Surgery (ISGPS) 2016 consensus.

Results

CR-POPF developed in 38 patients (24.2%). Multivariate logistic regression indicated that PV distance and BMI were potential candidates for predictive models for pancreatic fistula development, and small pancreatic duct diameter, diabetes mellitus development, and pathology of non-pancreatic cancers were independent factors for CR-POPF. When comparing the two risk models (PV distance- and BMI-based models), the PV distance-derived risk model was compatible to the BMI-based stratification models (area under the curve 0.831 vs. 0.830).

Conclusions

PV distance was confirmed to be a useful risk predictor for CR-POPF. This research highlighted the efficacy of abdominal thickness measurement, which is simple and easily applicable in the clinical setting.
Literatur
1.
Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J (1993) One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 217(5):430–435CrossRef
2.
Allen PJ (2014) Pasireotide for postoperative pancreatic fistula. N Engl J Med 371(9):875–876CrossRef
3.
Pessaux P, Sauvanet A, Mariette C, Paye F, Muscari F, Cunha AS, Sastre B, Arnaud JP (2011) Federation de recherche en C: external pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg 253(5):879–885CrossRef
4.
Wang SE, Chen SC, Shyr BU, Shyr YM (2016) Comparison of modified blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. HPB (Oxford) 18(3):229–235CrossRef
5.
Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Yamaue H (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244(1):1–7CrossRef
6.
Harnoss JC, Ulrich AB, Harnoss JM, Diener MK, Buchler MW, Welsch T (2014) Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery 155(1):47–57CrossRef
7.
Abe K, Kitago M, Shinoda M, Yagi H, Abe Y, Oshima G, Hori S, Yokose T, Endo Y, Kitagawa Y (2020) High risk pathogens and risk factors for postoperative pancreatic fistula after pancreatectomy; a retrospective case-controlled study. Int J Surg 82:136–142CrossRef
8.
Smits FJ, Molenaar IQ, Besselink MG, Busch OR, van Eijck CH, van Santvoort HC (2018) Dutch pancreatic cancer G: management of postoperative pancreatic fistula after pancreatoduodenectomy: high mortality after completion pancreatectomy: reply to: Bressan et al. completion pancreatectomy in the acute management of pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford) 20(12):1223CrossRef
9.
Williamsson C, Ansari D, Andersson R, Tingstedt B (2017) Postoperative pancreatic fistula-impact on outcome, hospital cost and effects of centralization. HPB (Oxford) 19(5):436–442CrossRef
10.
Roberts KJ, Sutcliffe RP, Marudanayagam R, Hodson J, Isaac J, Muiesan P, Navarro A, Patel K, Jah A, Napetti S et al (2015) Scoring system to predict pancreatic fistula after pancreaticoduodenectomy: a UK multicenter study. Ann Surg 261(6):1191–1197CrossRef
11.
Imanaga H (1960) A new method of pancreaticoduodenectomy designed to preserve liver and pancreatic function. Surgery 47:577–586PubMed
12.
Hishinuma S, Ogata Y, Matsui J, Ozawa I (1999) Evaluation of pylorus-preserving pancreatoduodenectomy with the Imanaga reconstruction by hepatobiliary and gastrointestinal dual scintigraphy. Br J Surg 86(10):1306–1311CrossRef
13.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG et al (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef
14.
Sandini M, Malleo G, Gianotti L (2016) Scores for prediction of fistula after pancreatoduodenectomy: a systematic review. Dig Surg 33(5):392–400CrossRef
15.
Mungroop TH, van Rijssen LB, van Klaveren D, Smits FJ, van Woerden V, Linnemann RJ, de Pastena M, Klompmaker S, Marchegiani G, Ecker BL et al (2019) Alternative fistula risk score for pancreatoduodenectomy (a-FRS): design and international external validation. Ann Surg 269(5):937–943CrossRef
16.
House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, Gonen M, Olson SH, Kurtz RC, Brennan MF et al (2008) Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 12(2):270–278CrossRef
17.
Park CM, Park JS, Cho ES, Kim JK, Yu JS, Yoon DS (2012) The effect of visceral fat mass on pancreatic fistula after pancreaticoduodenectomy. J Invest Surg 25(3):169–173CrossRef
18.
Uchida Y, Masui T, Nakano K, Yogo A, Sato A, Nagai K, Anazawa T, Takaori K, Tabata Y, Uemoto S (2019) Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery. The Br J Surg 106:616–625CrossRef
19.
Yamamoto Y, Sakamoto Y, Nara S, Esaki M, Shimada K, Kosuge T (2011) A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg 35(12):2747–2755CrossRef
20.
Maurovich-Horvat P, Massaro J, Fox CS, Moselewski F, O’Donnell CJ, Hoffmann U (2007) Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography. Int J Obes (Lond) 31(3):500–506CrossRef
21.
Fujita Y, Kitago M, Abe T, Itano O, Shinoda M, Abe Y, Yagi H, Hibi T, Ishii M, Nakano Y et al (2018) Evaluation of pancreatic fibrosis with acoustic radiation force impulse imaging and automated quantification of pancreatic tissue components. Pancreas 47(10):1277–1282CrossRef
22.
Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, Hattori M, Inokawa Y, Nomoto S, Fujiwara M et al (2014) Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg 18(6):1108–1115CrossRef
23.
Patel K, Teta A, Sukharamwala P, Thoens J, Szuchmacher M, DeVito P (2014) External pancreatic duct stent reduces pancreatic fistula: a meta-analysis and systematic review. Int J Surg 12(8):827–832CrossRef
24.
Sugiyama M, Suzuki Y, Nakazato T, Yokoyama M, Kogure M, Abe N (2016) Pancreatic duct holder and mucosa squeeze-out technique for duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy: propensity score matching analysis. World J Surg 40(12):3021–3028CrossRef
25.
Qin H, Luo L, Zhu Z, Huang J (2016) Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. a meta-analysis of randomized controlled trials. Int J Surg 36:18–24CrossRef
26.
Brem H, Tomic-Canic M (2007) Cellular and molecular basis of wound healing in diabetes. J Clin Invest 117(5):1219–1222CrossRef
27.
Srivastava S, Sikora SS, Pandey CM, Kumar A, Saxena R, Kapoor VK (2001) Determinants of pancreaticoenteric anastomotic leak following pancreaticoduodenectomy. ANZ J Surg 71(9):511–515CrossRef
28.
Chu CK, Mazo AE, Sarmiento JM, Staley CA, Adsay NV, Umpierrez GE, Kooby DA (2010) Impact of diabetes mellitus on perioperative outcomes after resection for pancreatic adenocarcinoma. J Am Coll Surg 210(4):463–473CrossRef
29.
Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD (2004) Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 8(8):951–959CrossRef
30.
Addeo P, Delpero JR, Paye F, Oussoultzoglou E, Fuchshuber PR, Sauvanet A, Sa Cunha A, Le Treut YP, Adham M, Mabrut JY et al (2014) Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French surgical association. HPB (Oxford) 16(1):46–55CrossRef
31.
Ellis RJ, Brock Hewitt D, Liu JB, Cohen ME, Merkow RP, Bentrem DJ, Bilimoria KY, Yang AD (2019) Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy. J Surg Oncol 119(8):1128–1134CrossRef
32.
Malleo G, Mazzarella F, Malpaga A, Marchegiani G, Salvia R, Bassi C, Butturini G (2013) Diabetes mellitus does not impact on clinically relevant pancreatic fistula after partial pancreatic resection for ductal adenocarcinoma. Surgery 153(5):641–650CrossRef
33.
Liu QY, Zhang WZ, Xia HT, Leng JJ, Wan T, Liang B, Yang T, Dong JH (2014) Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy. World J Gastroenterol: WJG 20(46):17491–17497CrossRef
34.
Hart PA, Bellin MD, Andersen DK, Bradley D, Cruz-Monserrate Z, Forsmark CE, Goodarzi MO, Habtezion A, Korc M, Kudva YC et al (2016) Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol 1(3):226–237CrossRef
Metadaten
Titel
Clinical Impact of Portal Vein Distance on Computed Tomography for Postoperative Pancreatic Fistula after Pancreatoduodenectomy
verfasst von
Yutaka Endo
Minoru Kitago
Masahiro Shinoda
Hiroshi Yagi
Yuta Abe
Go Oshima
Shutaro Hori
Takahiro Yokose
Kodai Abe
Ryo Takemura
Ryota Ishi
Yuko Kitagawa
Publikationsdatum
31.03.2021
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 7/2021
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-021-06076-6

Weitere Artikel der Ausgabe 7/2021

Letter to the Editor: Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta-analysis

  • Letter to the Editor

Outcomes Following Immediate Vertical Rectus Abdominis Myocutaneous (VRAM) Flap-Based Perineal Reconstruction Following Resectional Surgery For Pelvic Malignancies

  • Original Scientific Report

Development of a Rapid Intraoperative Point-of-Care Method Using Tissue Suspension to Differentiate Parathyroid Tissue: A Possible Substitute for Frozen Sections

  • Innovative Surgical Techniques Around the World

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

  • Open Access
  • Original Scientific Report

Conflicting Guidelines: A Systematic Review on the Proper Interval for Colorectal Cancer Treatment

  • Scientific Review

Yoga—An Alternative Form of Therapy in Patients with Blunt Chest Trauma: A Randomized Controlled Trial

  • Original Scientific Report

Neu im Fachgebiet Chirurgie

Akute Cholezystitis bei multimorbiden Älteren: Operation nicht sofort ausschließen!

Bei älteren, multimorbiden Menschen mit akuter Cholezystitis wird eine Operation häufig nicht erwogen. Eine Studie aus Philadelphia zeigt nun jedoch, dass auch diese Patientinnen und Patienten von einer chirurgischen Therapie profitieren können.

Was geschehen muss, damit Prähabilitation in die Leitlinien kommt

Eine Prähabilitation vor einem viszeralchirurgischen Eingriff ist Experten zufolge äußerst sinnvoll, dennoch wird sie in Leitlinien derzeit nicht empfohlen. Beim DCK erklärte Prof. Tim Vilz aus Bonn, woran das liegt und was benötigt wird, um die Situation zu ändern.

Thoracic-Outlet-Syndrom nur in Ausnahmefällen operieren!

Das Thoracic-Outlet-Syndrom erfordert nur in ganz bestimmten Fällen ein operatives Vorgehen. Beim DCK wurde vor schwerwiegenden Komplikationen des anspruchsvollen Eingriffs gewarnt.

Statine: Was der G-BA-Beschluss für Praxen bedeutet

Nach dem G-BA-Beschluss zur erweiterten Verordnungsfähigkeit von Lipidsenkern rechnet die DEGAM mit 200 bis 300 neuen Dauerpatienten pro Praxis. Im Interview erläutert Präsidiumsmitglied Erika Baum, wie Hausärztinnen und Hausärzte am besten vorgehen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise