Description

Timme et al evaluated risk factors for pancreatic fistula following pancreatoduodenectomy. These can help to identify a patient who may require more aggressive management. The authors are from the University of Freiburg, University Medical Center Schleswig-Holstein and Semmelweis University in Budapest.


Patient selection: status post pancreatoduodenectomy

 

Parameters:

(1) sex of the patient

(2) surgeon annual volume for pancreatoduodenectomies

(3) pancreatic texture

(4) histologic fibrosis of the pancreas

(4) renal comorbidity

 

Parameter

Finding

Odds Ratio

sex

female

1

 

male

3.122

surgeon volume

< 10

1

 

10 to 25

0.262

 

> 25

0.187

pancreatic texture

soft

2.754

 

firm

1

histologic fibrosis

HPF 0 (none)

1

 

HPF I (mild)

0.237

 

HPF 2 (moderate)

0.117

 

HPF 3 (severe with architectural destruction)

0.078

renal comorbidity

no

1

 

yes

0.271 (p value 0.138)

 

The authors postulated that fibrosis grading at the time of surgery by frozen section could help to guide management to reduce the risk.


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