Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group.
Several definitions for pancreatic leakage after pancreaticodoudenectomy exist, and the reported range of 2-50% underscores this variation. The goal was to determine if drain data alone was predictive of a leak and validate International Study Group on Pancreatic Fistula (ISGPF) leak criteria. Participating surgeons entered de-identified data into a web-based database designed to collect Whipple-related data. Definitions used were the ISGPF definition, > or = 3 days, amylase 3x normal; and Sarr's definition, > or = 5 days, amylase 5x normal, > 30 ml. We compared how well these two definitions were at detecting a leak and its complications. There were 1,507 cases submitted from 16 international institutions. A pancreaticoduodenectomy (PPPD) was performed in 76.2%. Drain placement occurred in 98.0%. Using the ISGPF definition, the pancreatic leak rate was 26.7 and 14.3% with the Sarr definition. There were more grades A and B leaks detected by the ISGPF definition. Both determined grade C leaks equally. Both definitions correlated with an increased length of stay (LOS), need for percutaneous drains, reoperation, and delayed gastric emptying (DGE). Neither was associated with an increased risk of intensive care unit (ICU) stay or 30-day mortality. The ISGPF was able to capture more patients with clinically relevant leaks than Sarr's criteria; however, the ability to detect a leak by drain data alone is imperfect.
Reid-Lombardo
Kaye M
KM
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.
Farnell
Michael B
MB
Crippa
Stefano
S
Barnett
Matthew
M
Maupin
George
G
Bassi
Claudio
C
Traverso
L William
LW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004322:Drainage; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology
Ann Surg. 2005 Dec;242(6):767-71, discussion 771-3
16327486
Arch Surg. 2003 Dec;138(12):1310-4; discussion 1315
14662530
Arch Surg. 1998 Oct;133(10):1094-8
9790207
Arch Surg. 2001 Apr;136(4):391-8
11296108
J Gastrointest Surg. 2004 Nov;8(7):766-72; discussion 772-4
15531229
Surgery. 2007 Apr;141(4):420-6
17383518
Ann Surg. 2002 Sep;236(3):355-66; discussion 366-8
12192322
J Gastrointest Surg. 2003 Sep-Oct;7(6):758-65
13129553
J Am Coll Surg. 2003 Apr;196(4):556-64; discussion 564-5; author reply 565
12691930
Dig Surg. 2004;21(1):54-9
14707394
HPB (Oxford). 2007;9(1):8-15
18333107
Dig Surg. 2001;18(6):453-7; discussion 458
11799295
Surgery. 2005 Oct;138(4):618-28; discussion 628-30
16269290
Ann Surg. 2001 Oct;234(4):487-93; discussion 493-4
11573042
Int J Pancreatol. 1998 Aug;24(1):23-9
9746886
Br J Surg. 2000 Jul;87(7):883-9
10931023
Br J Surg. 2005 Sep;92(9):1059-67
16044410
Br J Surg. 2006 Aug;93(8):929-36
16845693
J Gastrointest Surg. 2006 Apr;10(4):490-8
16627213
Ann Surg. 2007 Mar;245(3):443-51
17435552
Surgery. 2005 Jul;138(1):8-13
16003309