Post operative pancreatic fistula associated with failure to rescue on pancreatic cancer undergoing pancreatic resection: a single centre experience

Authors

  • Budhi Ida Bagus Department of Surgery, Sebelas Maret University, Indonesia
  • Metria Ida Bagus Medical Faculty, Sebelas Maret University, Indonesia
  • Widyanti Soewoto Department of Surgery, Sebelas Maret University, Indonesia
  • Hanis Setyono Department of Surgery, Sebelas Maret University, Indonesia
  • Wibisono Department of Surgery, Sebelas Maret University, Indonesia
  • Kristanto Yuli Yarso Department of Surgery, Sebelas Maret University, Indonesia

DOI:

https://doi.org/10.18203/2349-2902.isj20241137

Keywords:

Post operative pancreatic fistula, Failure to rescue, Postoperative infected wounds

Abstract

Pancreatic resection was known as the gold standard treatment for resectable pancreatic cancer.  Post operative pancreatic fistula was common following pancreatic resection for tumor of the pancreas (head, body or tail of the pancreas). According to the Clavien-Dindo classification, the presence of the pancreatic fistula after resection was associated with increased rate of morbidity and mortality for the patients. We would evaluate cases of resectable pancreatic cancer (head and tail of the pancreas) undergoing open pancreatic resection in our centre (low volume centre). Post operative pancreatic fistula were evaluated by abdominal CT scanning and increased amylase level from intra peritoneal drain. The patients whose cannot survive after pancreatic resection were classified as failure to rescue.  The presence of cardio-pulmonary morbidity was excluded from this study. Six cases were recorded in this study, 4 cases were head pancreatic cancer and 2 cases was tail pancreatic cancer. The histopathology results were acinar cell pancreatic cancer. Post operative pancreatic fistula was found on 1 case of head pancreatic cancer, classified as Clavien-Dindo grade IV, relaparotomy was done.  This patient had sepsis associated post operative pancreatic fistula and can not survive during evaluation (on 14th post operative days).  For the rest of the patients, there were no pancreatic fistula and had good outcome with no post operative morbidity. The presence of uncontrolled post operative pancreatic fistula was associated with failure to rescue on pancreatic cancer undergoing resection.

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References

Van Rijssen LB, Zwart MJ, Van Dieren S, De Rooij T, Bonsing BA, Bosscha K, et al. Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit. HPB. 2018;20:759-67.

Wroński M, Cebulski W, Witkowski B, Guzel T. Surgical management of the grade C pancreatic fistula after pancreatoduodenectomy. HPB (Oxford). 2019;21(9):1166-74.

Zhou YM, Zhou X, Wan T, Xu D, Si XY. An evidence-based approach to the surgical interventions for severe pancreatic fistula after pancreatoduodenectomy. Surgeon. 2018;16(2):119-24.

Paye F, Lupinacci RM, Kraemer A, Lescot T, Chafaï N, Tiret E, et al. Surgical treatment of severe pancreatic fistula after pancreaticoduodenectomy by wirsungostomy and repeat pancreatico-jejunal anastomosis. Am J Surg. 2013;2016(2):194-201.

Smits FJ, Van Santvoort HC, Besselink MG, Batenburg MCT, Slooff RAE, Boerma D, et al. Management of Severe Pancreatic Fistula After Pancreatoduodenectomy. JAMA Surg. 2017;152(6):540-8.

Ma T, Bai X, Chen W, Li G, Lao M, Liang T. Pancreas-preserving management of grade-C pancreatic fistula and a novel bridging technique for repeat pancreatico-jejunostomy: An observational study. Int J Surg. 2018;52:243-7.

De Castro SMM, Busch ORC, Van Gulik TM, Obertop H, Gouma DJ. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg. 2005;92(9):1117-23.

Bassi C, Dervenis C, Butturini G, Abe F, Charles Y, Jakob I, et al. International Study Group on Pancreatic Fistula Definition Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13.

Fuks D, Piessen G, Huet E, Marion T, Philippe Z, Francis M, et al. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg. 2009;197(6):702-9.

Malleo G, Pulvirenti A, Marchegiani G, Butturini G, Salvia R, Bassi C. Diagnosis and management of postoperative pancreatic fistula. Langenbecks Arch Surg. 2014;399(7):801-10.

Hackert T, Werner J, Büchler MW. Postoperative pancreatic fistula. Surgeon. 2011;9(4):211-7.

Schmidt CM, Choi J, Powell ES, Yiannoutsos CT, Zyromski NJ, Nakeeb A, et al. Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes. HPB Surg. 2009;2009:404520.

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Published

2024-04-29

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Case Series