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Annali Italiani di Chirurgia
Edizioni Luigi Pozzi
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| Abstract: |
Pancreatic surgery e pancreatic stula (POPF) is a potentially fatal sequela with substantial morbidity and mortality.
POPF incidence and risk factors vary. is study aimed to evaluate the incidence and risk factors of patients with pancreatic
stula (PF) from patients undergoing various pancreatic surgeries for dierent pancreatic diseases.
MATERIAL AND METHODS: A retrospective observational study was conducted in the surgical unit of our university hospitals
from July 2014 to July 2019. ree hundred forty-seven patients were admitted with a clinical diagnosis of pancreatic
stula following both open and laparoscopic approaches for pancreatic benign and malignant tumors.
RESULTS: e most prevalent age was >60 years (67%), with a male predominance (83%). e most common diagnosis
before surgery was pancreatic head adenocarcinoma (32%), followed by duodenal neoplasm (19%) and true epithelial
pancreatic cystic neoplasms (18%), ampullary neoplasms (15%), bile duct neoplasms (12%), neuroendocrine neoplasms
(2%), and chronic pancreatitis (2%). e most prevalent site of the pancreatic tumor was the head (87%),
while accompanied Jaundice (47%) and epigastric discomfort (37%) were the commonest presentations before surgery.
Pancreatic duct diameter greater than 3 mm was present in 208 patients (60%), tumor size greater than 3 cm in
63%, hard pancreatic texture in 67%, and preoperative ERCP with a stent in 37% of cases. Tumor in the tail of
the pancreas was found in 5% (17 patients) of cases. e commonest operations performed were open pylorus-preserving
pancreaticoduodenectomy, open pancreaticoduodenectomy without pylorus-preserving, and open distal pancreatectomy
with splenic preservation. Postoperative pancreatic stula occurred in 8% of cases (27), with ISPGF grade A (biochemical
leak) occurring in 17 patients (17/27) and clinically signicant POPF occurring in 10 patients (10/27). POPF occurred
in 13 patients after distal pancreatectomy, 11 patients after pancreaticoduodenectomy, two cases followed central pancreatectomy,
and one. Grade B after pancreaticoduodenectomy and two after distal pancreatectomy. Grade C POPF
occurred in four patients after pancreaticoduodenectomy but not after distal pancreatectomy. Age >55 (p=0.00), male
(p=0.03), presence of symptom (p=0.0008), location at Head of the pancreas (p=0.0004), elevated CA19-9 (p=0.0004),
jaundice (p=0.0001) and pancreatic texture (p=0.00**).
CONCLUSION: Pancreatic stula occurred in 27 patients (8%), a comparatively low incidence. POPF was linked to age,
Jaundice, gender, pancreatic head cancer, symptoms, high CA 19-9, jaundice, and a soft pancreas. POPF incidence was
higher after distal pancreatectomy, whereas POPF severity was higher after pancreaticoduodenectomy
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