title: Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes.
abstract: Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.
authors.affiliation: Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA. maxschmi@iupui.edu
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Jennifer
authors.initials: J
authors.lastname: Choi
authors.forename: Emilie S
authors.initials: ES
authors.lastname: Powell
authors.forename: Constantin T
authors.initials: CT
authors.lastname: Yiannoutsos
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Eric A
authors.initials: EA
authors.lastname: Wiebke
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D015994:Incidence; D007196:Indiana / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric