title: A comparative analysis of postoperative pancreatic fistulas after surgery with and without hyperthermic intraperitoneal chemoperfusion.
abstract: BACKGROUND
  Postoperative pancreatic fistulas (POPFs) are potentially morbid complications that often require therapeutic interventions. Distal pancreatectomy performed during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) puts patients at risk for POPF. The authors hypothesized that POPFs are more severe after CRS/HIPEC than after pancreatectomy alone.
  
  
  METHODS
  Clinicopathologic and perioperative details, including POPF by International Study Group of Pancreatic Fistula criteria (ISGPF), and oncologic outcomes for patients undergoing distal pancreatectomy during CRS/HIPEC for peritoneal carcinomatosis of appendiceal (n = 31) or colorectal (n = 23) origin (HIPEC group) were compared with those for patients undergoing minimally invasive or open distal pancreatectomy without HIPEC (n = 66) for locally resectable pancreatic adenocarcinoma (non-HIPEC group).
  
  
  RESULTS
  The incidence of POPF was similar between the HIPEC and non-HIPEC groups (26 %). The severity of POPF according to the ISGPF criteria was significantly worse in the HIPEC group. The HIPEC patients had 13 grade B fistulas and 1 grade C fistula compared with 12 grade A fistulas and 4 grade B fistulas in the non-HIPEC group. The HIPEC patients with POPF did not differ in the extent of their CRS, peritoneal cancer index, length of hospital stay, or other postoperative complications from the the HIPEC patients without POPF. The HIPEC patients with colorectal carcinomatosis who experienced POPF had higher disease recurrence in the first year after CRS/HIPEC than those without POPF.
  
  
  CONCLUSIONS
  The findings showed that POPFs are more severe when distal pancreatectomy is combined with CRS/HIPEC. Moreover, selective use of distal pancreatectomy is important during CRS/HIPEC because POPFs may increase early disease recurrence for patients with colorectal carcinomatosis.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA, downscannersm@upmc.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Downs-Canner
authors.forename: Ying
authors.initials: Y
authors.lastname: Ding
authors.forename: Deepa R
authors.initials: DR
authors.lastname: Magge
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.forename: Amer
authors.initials: A
authors.lastname: Zureikat
authors.forename: Matthew
authors.initials: M
authors.lastname: Holtzman
authors.forename: Steven
authors.initials: S
authors.lastname: Ahrendt
authors.forename: James
authors.initials: J
authors.lastname: Pingpank
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate