Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula

John W. Lin, John L. Cameron, Charles J. Yeo, Taylor S. Riall, Keith D. Lillemoe

Research output: Contribution to journalArticle

276 Citations (Scopus)

Abstract

A significant fraction of patients undergoing pancreaticoduodenectomy develop a postoperative pancreaticocutaneous fistula. To identify risk factors for this complication and to delineate its impact on patient outcomes, we conducted a retrospective review of 1891 patients undergoing pancreaticoduodenectomy between 1981 and 2002. Overall, 216 patients (11.4%) developed a postoperative pancreaticocutaneous fistula. In univariate analysis, gender, coronary disease, diabetes mellitus, operative times, blood loss, radical lymphadenectomy, gland texture, and specimen pathology correlated with fistula rates. In a multivariate model, however, only gland texture and coronary disease were statistically predictive. A soft gland was associated with a 22.6% fistula rate, a 20.4-fold increase in fistula risk over those patients with a medium or firm gland (95% confidence interval, 4.7-90.9). No patient with a firm gland developed a fistula. Although 30-day postoperative mortality was not different between those patients with and those without fistula (1.4% versus 1.5%), the mean length of stay was longer (26.0 days versus 13.2 days) and the rates of certain complications were increased in those patients with fistula. In this single-institution experience, pancreaticocutaneous fistula was most strongly predicted by pancreatic texture. Choice of anastomotic technique did not correlate with fistula rates. Pancreaticocutaneous fistula increases postoperative length of stay and morbidity but was not directly associated with increased postoperative mortality.

Original languageEnglish (US)
Pages (from-to)951-959
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume8
Issue number8
DOIs
StatePublished - Dec 1 2004
Externally publishedYes

Fingerprint

Fistula
Pancreaticoduodenectomy
Coronary Disease
Length of Stay
Mortality
Operative Time
Lymph Node Excision
Diabetes Mellitus
Confidence Intervals
Pathology
Morbidity

Keywords

  • morbidity
  • mortality
  • pancreatic fistula
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. / Lin, John W.; Cameron, John L.; Yeo, Charles J.; Riall, Taylor S.; Lillemoe, Keith D.

In: Journal of Gastrointestinal Surgery, Vol. 8, No. 8, 01.12.2004, p. 951-959.

Research output: Contribution to journalArticle

Lin, John W. ; Cameron, John L. ; Yeo, Charles J. ; Riall, Taylor S. ; Lillemoe, Keith D. / Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. In: Journal of Gastrointestinal Surgery. 2004 ; Vol. 8, No. 8. pp. 951-959.
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abstract = "A significant fraction of patients undergoing pancreaticoduodenectomy develop a postoperative pancreaticocutaneous fistula. To identify risk factors for this complication and to delineate its impact on patient outcomes, we conducted a retrospective review of 1891 patients undergoing pancreaticoduodenectomy between 1981 and 2002. Overall, 216 patients (11.4{\%}) developed a postoperative pancreaticocutaneous fistula. In univariate analysis, gender, coronary disease, diabetes mellitus, operative times, blood loss, radical lymphadenectomy, gland texture, and specimen pathology correlated with fistula rates. In a multivariate model, however, only gland texture and coronary disease were statistically predictive. A soft gland was associated with a 22.6{\%} fistula rate, a 20.4-fold increase in fistula risk over those patients with a medium or firm gland (95{\%} confidence interval, 4.7-90.9). No patient with a firm gland developed a fistula. Although 30-day postoperative mortality was not different between those patients with and those without fistula (1.4{\%} versus 1.5{\%}), the mean length of stay was longer (26.0 days versus 13.2 days) and the rates of certain complications were increased in those patients with fistula. In this single-institution experience, pancreaticocutaneous fistula was most strongly predicted by pancreatic texture. Choice of anastomotic technique did not correlate with fistula rates. Pancreaticocutaneous fistula increases postoperative length of stay and morbidity but was not directly associated with increased postoperative mortality.",
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