Highlights
- •Post-operative pancreatic fistula is higher in pancreatic neuroendocrine tumors.
- •Male sex, pancreaticoduodenectomy, small duct, and soft gland have higher leak rate.
- •Tumor stage, nodes, metastasis, race, and age were not associated with leak rate.
- •Functioning and non-functioning tumors had similar post-operative leak rates.
- •Post-operative pancreatic fistula rates did not change between 2014 and 2018.
Abstract
Background
Post-operative pancreatic fistula (POPF) is a serious complication following pancreas
surgery. We aimed to establish factors associated with POPF specifically in patients
with pancreatic neuroendocrine tumors (PNET).
Methods
The 2014–2018 American College of Surgeons National Surgical Quality Improvement Program
database was querried for patients undergoing resection for PNET. The impact of patient,
tumor, and operative factors on POPF formation was evaluated.
Results
3532 patient underwent resections for PNET. The POPF rate was significantly higher
in patients with PNET (24.8%) versus non-PNET (16.4%) (p < 0.0001). Male sex (OR 1.45,
95% CI 1.11–1.89), enucleation (OR 3.14, 95% CI 1.10–8.98), pancreaticoduodenectomy
(OR 1.51, 95% CI 1.13–2.03), small duct size <3 mm (OR 3.24, 95% CI 1.62–6.48), and
soft gland texture (OR 1.81, 95% CI 1.18–2.77) were independently associated with
POPF in PNET patients on multivariable analysis.
Conclusions
POPF is more common in patients undergoing resection for PNET and is dictated primarily
by surgical approach and gland characteristics.
Keywords
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References
- Pancreatic fistula: definition and current problems.J Hepatobiliary Pancreat Surg. 2008; 15: 247-251
- Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation.Br J Surg. 2003; 90: 190-196
- Using the NSQIP pancreatic demonstration Project to derive a modified fistula risk score for preoperative risk stratification in patients undergoing pancreaticoduodenectomy.J Am Coll Surg. 2017; 224: 816-825
- Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. 2005; 138: 8-13
- Pickleman J Current management of pancreatic fistula after pancreaticoduodenectomy.Surgery. 2006; 140 (discussion 568-569): 561-568
- Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases.Ann Surg. 2007; 245: 573-582
- Pasireotide for postoperative pancreatic fistula.N Engl J Med. 2014; 370: 2014-2022
- Outcomes after pancreatectomy with routine pasireotide use.J Am Coll Surg. 2019; 228: 161-170.e162
- Prevention and management of pancreatic fistula.J Gastrointest Surg. 2009; 13: 163-173
- Keutgen XM Operative resection in early stage pancreatic neuroendocrine tumors in the United States: are we over- or undertreating patients?.Surgery. 2020; 167: 180-186
- ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors.Neuroendocrinology. 2016; 103: 153-171
- the North American neuroendocrine tumor society consensus paper on the surgical management of pancreatic neuroendocrine tumors.Pancreas. 2020; 49: 1-33
- The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.Surgery. 2017; 161: 584-591
- Extrapolation of fistula grade from the pancreatectomy participant use file of the American College of surgeons national surgical quality improvement Program (ACS-NSQIP).Surgery. 2018; 164: 1126-1134
- Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions.HPB (Oxford). 2015; 17: 38-45
- Risk and predictors of postoperative morbidity and mortality after pancreaticoduodenectomy for pancreatic neuroendocrine neoplasms: a comparative study with pancreatic ductal adenocarcinoma.Pancreas. 2019; 48: 504-509
- Association between pancreatic fistula and long-term survival in the era of neoadjuvant chemotherapy.JAMA Surg. 2019; 154: 943-951
- Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture.HPB (Oxford). 2018; 20: 992-1003
- Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes.J Surg Oncol. 2016; 113: 784-788
- Prospective evaluation of pasireotide in patients undergoing pancreaticoduodenectomy: the Washington university experience.J Am Coll Surg. 2018; 226: 147-154.e141
- Carcinoid and neuroendocrine tumors: building on success.J Clin Oncol. 2015; 33: 1855-1863
- Clinical characteristics of pancreatic neuroendocrine tumors in Japanese patients with von Hippel-Lindau disease.Pancreas. 2006; 33: 382-385
Article info
Publication history
Published online: August 09, 2022
Accepted:
July 14,
2022
Received in revised form:
June 4,
2022
Received:
February 8,
2022
Identification
Copyright
Published by Elsevier Inc.