Original Article
Risk Factors And Outcome of Pancreatic Fistula after Consecutive Pancreaticoduodenectomy with Pancreaticojejunostomy for Patients with Malignant Tumor
Abstract
Objective: Pancreatic fistula (PF) is a common complication after pancreaticoduodenectomy (PD) and there is no consensus regarding the criteria to define PF. The study was undertaken to determine the risk factors for PF according to the definition of the International Study Group on Pancreatic Fistula (ISGPF) and to delineate its impact on patient outcome.
Methods: Between March 1994 and May 2009, data from 153 consecutive patients with malignant tumors underwent a PD with pancreaticojejunostomy in the Peking University People’s Hospital were recorded prospectively. A total of 24 factors were examined with univariate analysis and multivariate logistic regression analysis was used to estimate relative risks, and their 95% confidence intervals (95% CI) and odds ratio (OR).
Results: Our institution belonged to medium-volume center and PF occurred in 30 patients (19.6%). Pancreatic texture, early postoperative hemorrhage and pancreatic pathologies correlated with PF rates significantly in univariate analyses. But in multivariate regression, soft gland (OR, 4.934; 95% CI, 1.132−7.312) and early postoperative hemorrhage with conservative therapy (OR, 4.130; 95% CI, 1.057−21.112) were predictive. The mean postoperative length of stay in patients with PF was longer (32.7±23.9 versus 60.5±56.2 days) than patients without PF (P=0.001). Overall 30-day mortality was not affected by the development of PF (P=0.657). There was no difference in reoperation rates between patients with and without PF (10.0% versus 6.5%, P=0.787). Concerning the sum of postoperative complications, there were 36 complications for 30 patients with PF, while 64 for 123 patients without PF. When patients with distal cholangiocarcinoma, ampullary and duodenal cancer were considered as a whole for survival analysis, the median survival for patients with PF was 20 months, whereas the median survival for patients without PF was 26 months. Kaplan-Meier survival curves for patients with and without PF were not statistically different (P=0.903).
Conclusion: Soft texture and early postoperative hemorrhage with conservative therapy are independent correlates of increased rate of PF. Anastomotic technique for pancreaticojejunostomy does not have impact on the development of PF in our experience. PF contributes to early postoperative morbidity and the length of hospital stay, but it dose not affect postoperative 30-day mortality, reoperation rate and overall survival.
Methods: Between March 1994 and May 2009, data from 153 consecutive patients with malignant tumors underwent a PD with pancreaticojejunostomy in the Peking University People’s Hospital were recorded prospectively. A total of 24 factors were examined with univariate analysis and multivariate logistic regression analysis was used to estimate relative risks, and their 95% confidence intervals (95% CI) and odds ratio (OR).
Results: Our institution belonged to medium-volume center and PF occurred in 30 patients (19.6%). Pancreatic texture, early postoperative hemorrhage and pancreatic pathologies correlated with PF rates significantly in univariate analyses. But in multivariate regression, soft gland (OR, 4.934; 95% CI, 1.132−7.312) and early postoperative hemorrhage with conservative therapy (OR, 4.130; 95% CI, 1.057−21.112) were predictive. The mean postoperative length of stay in patients with PF was longer (32.7±23.9 versus 60.5±56.2 days) than patients without PF (P=0.001). Overall 30-day mortality was not affected by the development of PF (P=0.657). There was no difference in reoperation rates between patients with and without PF (10.0% versus 6.5%, P=0.787). Concerning the sum of postoperative complications, there were 36 complications for 30 patients with PF, while 64 for 123 patients without PF. When patients with distal cholangiocarcinoma, ampullary and duodenal cancer were considered as a whole for survival analysis, the median survival for patients with PF was 20 months, whereas the median survival for patients without PF was 26 months. Kaplan-Meier survival curves for patients with and without PF were not statistically different (P=0.903).
Conclusion: Soft texture and early postoperative hemorrhage with conservative therapy are independent correlates of increased rate of PF. Anastomotic technique for pancreaticojejunostomy does not have impact on the development of PF in our experience. PF contributes to early postoperative morbidity and the length of hospital stay, but it dose not affect postoperative 30-day mortality, reoperation rate and overall survival.
