Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: How We Do It

Simple Summary Pancreatic cancer is one of the most aggressive solid tumors with a very poor prognosis. The only opportunity for long-term survival is surgical resection in combination with chemotherapy. Pancreatic surgery, however, is a highly complex and technical challenging procedure, even if carried out by very experienced surgeons. One of the most feared complications after pancreatic surgery is leakage of pancreatic fluid into the abdominal cavity, where it can lead to other serious complications, such as abscess formation, impaired gastric motility and severe bleeding with subsequent death. The goal of this study was to investigate possible risk factors for the leakage of pancreatic fluid and to analyze possible treatment strategies. Our data show that patients developing leakage of pancreatic fluid were younger, mainly male, with fewer comorbidities and with a higher body mass index. Also, they had a smaller tumor size and softer pancreatic parenchyma. In general, these patients showed a worse outcome leading to a prolonged hospital stay; however, this did not affect the overall mortality rate. Treatment strategies included conservative treatment, drainage placement, endoscopic negative pressure therapy and surgery. The majority of the patients were able to receive conservative treatment, resulting in a shorter length of their hospital stay. (1) Background: This study's goals were to investigate possible risk factors for clinically relevant postoperative pancreatic fistula (POPF) grade B/C according to the updated definitions of the International Study Group of Pancreatic Surgery and to analyze possible treatment strategies; (2) Methods: Between 2017 and 2021, 200 patients were analyzed regarding the development of POPF grade B/C with an emphasis on postoperative outcome and treatment strategies; (3) Results: POPF grade B/C was observed in 39 patients (19.5%). These patients were younger, mainly male, had fewer comorbidities and showed a higher body mass index. Also, they had lower CA-19 levels, a smaller tumor size and softer pancreatic parenchyma. They experienced a worse outcome without affecting the overall mortality rate (10% vs. 6%, p = 0.481), however, this lead to a prolonged postoperative stay (28 (32-36) d vs. 20 (15-28) d, p <= 0.001). The majority of patients with POPF grade B/C were able to receive conservative treatment, followed by drainage placement, endoscopic vacuum-assisted therapy (EVT) and surgery. Conservative treatment resulted in a shorter length of the postoperative stay (24 (22-28) d vs. 34 (26-43) d, p = 0.012); (4) Conclusions: Patients developing POPF grade B/C had a worse outcome; however, this did not affect the overall mortality rate. The majority of the patients were able to receive conservative treatment, resulting in a shorter length of their hospital stay.

Automated summary

Pancreatic cancer is a highly aggressive tumor with poor prognosis. Surgery combined with chemotherapy is the only chance for long-term survival, but it is a complex procedure with risks of complications. This study investigated the risk factors and treatment strategies for leakage of pancreatic fluid after surgery. The data showed that patients with leakage were younger, mainly male, with fewer comorbidities, higher body mass index, smaller tumor size, and softer pancreatic parenchyma. Treatment strategies included conservative treatment, drainage placement, endoscopic negative pressure therapy and surgery. Most patients received conservative treatment, resulting in shorter hospital stays.