Clinical Practice Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2017; 9(12): 270-280
Published online Dec 27, 2017. doi: 10.4240/wjgs.v9.i12.270
Risk factors for pancreatic fistula following pancreaticoduodenectomy: A retrospective study in a Thai tertiary center
Narongsak Rungsakulkij, Somkit Mingphruedhi, Pongsatorn Tangtawee, Chonlada Krutsri, Paramin Muangkaew, Wikran Suragul, Penampai Tannaphai, Suraida Aeesoa
Narongsak Rungsakulkij, Somkit Mingphruedhi, Pongsatorn Tangtawee, Chonlada Krutsri, Paramin Muangkaew, Wikran Suragul, Suraida Aeesoa, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Penampai Tannaphai, Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Rungsakulkij N contributed to design of the work, data collection, interpretation of data, writing and drafting the work; Mingphruedhi S, Tangtawee P and Krutsri C contributed to data collection and analysis; Muangkaew P, Suragul W and Tannapai P contributed to data collection; Aeesoa S contributed to data analysis.
Institutional review board statement: The study was reviewed and approved by the Ramathibodi Hospital Institutional Review Board Committee on Human Rights Related to Research Involving Human Subjects. The protocol number is ID 12-59-50.
Informed consent statement: Not applicable.
Conflict-of-interest statement: All authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Narongsak Rungsakulkij, MD, FRCS (Gen Surg), Lecturer, Surgeon, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ramathibodi Hospital, 270 Praram VI road, Ratchathewi, Bangkok 10400, Thailand. narongsak.run@mahidol.ac.th
Telephone: +66-2-2011527 Fax: +66-2-2012471
Received: July 24, 2017
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

The aim of this study was to analyze the risk factors of POPF following PD in a Thai tertiary care center.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.