Kumar Suneed, Chandra Abhijit, Madhavan Shibumon M, Kumar Dinesh, Chauhan Smita, Pandey Anshuman, Masood Shakeel
Department of Surgical Gastroenterology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow, Uttar Pradesh 226010 India.
Department of Surgical Gastroenterology, King George Medical University, Lucknow, Uttar Pradesh India.
Indian J Surg Oncol. 2021 Mar;12(1):22-30. doi: 10.1007/s13193-020-01195-3. Epub 2020 Aug 27.
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 ( = 0.403), but was significantly associated with increased incidence of post-pancreatectomy hemorrhagic ( = 0.005) and infectious complications ( = 0.013). Soft pancreas ( = 0.024), intraoperative blood loss ( = 0.045), blood transfusion ( = 0.024), and fistula risk score ( = 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; < 0.001) significantly predicted crPOPF with good sensitivity and specificity. POD1 DFA was only factor significant on multivariate analysis ( = 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.
胰肠吻合口漏后形成的瘘是胰十二指肠切除术（PD）常见的、潜在致命的并发症。早期评估和预测其发生可改善术后结局。分析了各种围手术期因素对临床相关术后胰瘘（crPOPF）的影响。此外，还研究了有瘘和无瘘患者临床结局的差异。在一项双机构研究中，对67例因恶性肿瘤接受PD手术的患者进行了为期3年的分析。评估了各种术前、术中和术后因素。观察了POPF的发生率和严重程度及其与其他PD术后并发症发生的关联。将有和无POPF的患者分为两组，进行单因素和多因素分析比较，以确定重要的促成因素。20.9%的病例存在临床相关的POPF。crPOPF导致胃排空延迟，尽管不显著（P = 0.403），但与胰切除术后出血（P = 0.005）和感染性并发症（P = 0.013）的发生率增加显著相关。胰腺质地软（P = 0.024）、术中失血（P = 0.045）、输血（P = 0.024）和瘘风险评分（P = 0.001）是crPOPF的显著预测因素。术后第1天（POD1）引流液淀粉酶（DFA）值在截断值1336 U/L时（AUC = 0.871；P < 0.001），以良好的敏感性和特异性显著预测crPOPF。POD1 DFA是多因素分析中唯一显著的因素（P = 0.014）。两组间总生存率无显著差异。crPOPF导致胰切除术后显著的出血和感染并发症，以及死亡率增加。它可通过几个术前和术中因素准确预测。POD1 DFA可独立预测crPOPF的发生。
