Published online Dec 27, 2017. doi: 10.4240/wjgs.v9.i12.270
Peer-review started: July 26, 2017
First decision: September 11, 2017
Revised: September 15, 2017
Accepted: October 30, 2017
Article in press: October 30, 2017
Published online: December 27, 2017
Processing time: 155 Days and 19.1 Hours
Many risk factors have been reported for postoperative pancreatic fistula (POPF), including obesity, soft pancreatic texture, small pancreatic duct and low volume center. Some studies have investigated ways to improve the surgical outcome and reduce POPF, including the placement of an external and internal trans-anastomotic pancreatic duct, pancreatogastrostomy, omental roll-up around pancreaticoenteric (PE) anastomosis, application of fibrin sealants around PE anastomosis and prophylaxis with somatostatin analogs. However, the outcomes of these different methods remain controversial. Recently, a soft pancreas and high body mass index (BMI) were reported as the most common risk factors for POPF. However, POPF risk factors have not been studied in a Thai population before. The aim of this study was to analyze the risk factors of POPF following PD in a Thai tertiary care center.
The most common perioperative complication of pancreaticoduodenectomy is POPF. POPF remains the leading cause of complications such as DGE and postoperative hemorrhage, which increase mortality and the LOH. Many risk factors for POPF have been reported previously.
The aim of this study was to analyze the risk factors of POPF following PD in a Thai tertiary care center.
The retrospective study design were required by reviewed data from January 2001 to December 2016, 210 consecutive patients underwent PD at the Department of Surgery in Ramathibodi Hospital, Bangkok, Thailand.
This is the study from tertiary care center from Thailand. To the best of the authors knowledge, this is the largest study from Thailand. The authors found that soft pancreatic tissue is the most significant risk factor for postoperative pancreatic fistula. A high preoperative serum bilirubin level (> 3 mg/dL) is the most significant risk factor for clinically relevant pancreatic fistula.
The authors have identified a soft pancreas as an independent risk factor of POPF. A fatty pancreas is strongly associated with a soft pancreas and can be measured to predict CR-POPF. Preoperative detection of a fatty pancreas by CT is a potential method for predicting a soft pancreas preoperatively. Recently, the newly developed technology of ultrasonography have high accuracy to prediction of the stiffness of pancreas preoperatively. However, this needs to be confirmed by large population studies. At the moment, PBD is not routinely recommended because the rate of infectious complications is higher. Further studies are required to clarify the link between preoperative obstructive jaundice and CR-POPF.
Preoperative detection of a fatty pancreas by CT and newly developed ultrasound technology is a potential method for predicting a soft pancreas preoperatively. which needs to be confirmed by large population studies. At the moment, PBD is not routinely recommended because the rate of infectious complications is higher. Further studies are required to clarify the link between preoperative obstructive jaundice and CR-POPF.