Pancreas-preserving management in reinterventions for severe pancreatic fistula after pancreatoduodenectomy: a systematic review.
Identifieur interne : 000303 ( Main/Exploration ); précédent : 000302; suivant : 000304Pancreas-preserving management in reinterventions for severe pancreatic fistula after pancreatoduodenectomy: a systematic review.
Auteurs : Ahmed Fouad Bouras [France] ; Hélène Marin [France] ; Chafik Bouzid [Algérie] ; François-René Pruvot [France] ; Philippe Zerbib [France] ; Stéphanie Truant [France]Source :
- Langenbeck's archives of surgery [ 1435-2451 ] ; 2016.
Descripteurs français
- KwdFr :
- Complications postopératoires (thérapie), Complications postopératoires (étiologie), Duodénopancréatectomie (effets indésirables), Fistule pancréatique (thérapie), Fistule pancréatique (étiologie), Humains (MeSH), Pancréatectomie (MeSH), Réintervention (MeSH), Résultat thérapeutique (MeSH), Traitements préservant les organes (MeSH).
- MESH :
- effets indésirables : Duodénopancréatectomie.
- thérapie : Complications postopératoires, Fistule pancréatique.
- étiologie : Complications postopératoires, Fistule pancréatique.
- Humains, Pancréatectomie, Réintervention, Résultat thérapeutique, Traitements préservant les organes.
English descriptors
- KwdEn :
- MESH :
- adverse effects : Pancreaticoduodenectomy.
- etiology : Pancreatic Fistula, Postoperative Complications.
- therapy : Pancreatic Fistula, Postoperative Complications.
- Humans, Organ Sparing Treatments, Pancreatectomy, Reoperation, Treatment Outcome.
Abstract
BACKGROUND
Life-threatening postoperative pancreatic fistula (LTPOPF) is the most feared complication after pancreatoduodenectomy (PD). Although completion pancreatectomy (CP) is usually performed when radiological management fails, the associated morbidity and mortality rates remain high. Here, we reviewed pancreas-preserving alternatives to CP.
METHODS
The PubMed database was systematically searched for publications between 1983 and 2014, describing pancreas-preserving surgical treatment of the pancreas remnant (PR) after reintervention in a context of post-PD LTPOPF.
RESULTS
A total of 12 articles including 140 patients were reviewed. Six different types of pancreas-preserving treatment were described: external wirsungostomy, simple drainage of the PF, closure of pancreatic stump, internal wirsungostomy, partial CP, and salvage pancreatogastrostomy after major leakage of a pancreatojejunostomy. The overall median survival rate was 75 % but rose to 83 % when patients undergoing only surgical drainage of the fistula were excluded. The median complication rate was 75 %, and the median length of hospital stay was 41.5 days. Further reintervention was required for 25 % of the patients. The median incidence of late diabetes was 22.5 %. The incidence of exocrine insufficiency ranged from 0 to 100 % depending on the intervention.
CONCLUSION
Pancreas-preserving surgical management of the PR after LTPOPF can be performed with acceptable mortality and morbidity. These data suggest that CP should have a more precisely specified role in the management algorithm and should not be performed systematically.
DOI: 10.1007/s00423-015-1357-0
PubMed: 26586034
Affiliations:
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wicri:level="3"><nlm:affiliation>Department of General and Digestive Surgery, Centre Hospitalier de Béthune, BP 10809, 62408, Béthune cedex, France. afouadbouras@gmail.com.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of General and Digestive Surgery, Centre Hospitalier de Béthune, BP 10809, 62408, Béthune cedex</wicri:regionArea><placeName><region type="region" nuts="2">Hauts-de-France</region><region type="old region" nuts="2">Nord-Pas-de-Calais</region><settlement type="city">Béthune</settlement></placeName></affiliation></author><author><name sortKey="Marin, Helene" sort="Marin, Helene" uniqKey="Marin H" first="Hélène" last="Marin">Hélène Marin</name><affiliation wicri:level="3"><nlm:affiliation>Department of Digestive Surgery and Transplantation, Hôpital Huriez, CHU de Lille, Université Nord de France, Rue Michel Polonovski, 59037, Lille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of 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Transplantation, Hôpital Huriez, CHU de Lille, Université Nord de France, Rue Michel Polonovski, 59037, Lille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Digestive Surgery and Transplantation, Hôpital Huriez, CHU de Lille, Université Nord de France, Rue Michel Polonovski, 59037, Lille</wicri:regionArea><placeName><region type="region" nuts="2">Hauts-de-France</region><region type="old region" nuts="2">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Truant, Stephanie" sort="Truant, Stephanie" uniqKey="Truant S" first="Stéphanie" last="Truant">Stéphanie Truant</name><affiliation wicri:level="3"><nlm:affiliation>Department of Digestive Surgery and Transplantation, Hôpital Huriez, CHU de Lille, Université Nord de France, Rue Michel Polonovski, 59037, Lille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Digestive Surgery and Transplantation, Hôpital Huriez, CHU de Lille, Université Nord de France, Rue Michel Polonovski, 59037, Lille</wicri:regionArea><placeName><region type="region" nuts="2">Hauts-de-France</region><region type="old region" nuts="2">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author></analytic><series><title level="j">Langenbeck's archives of surgery</title><idno type="eISSN">1435-2451</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Humans (MeSH)</term><term>Organ Sparing Treatments (MeSH)</term><term>Pancreatectomy (MeSH)</term><term>Pancreatic Fistula (etiology)</term><term>Pancreatic Fistula (therapy)</term><term>Pancreaticoduodenectomy (adverse effects)</term><term>Postoperative Complications (etiology)</term><term>Postoperative Complications (therapy)</term><term>Reoperation (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Complications postopératoires (thérapie)</term><term>Complications postopératoires (étiologie)</term><term>Duodénopancréatectomie (effets indésirables)</term><term>Fistule pancréatique (thérapie)</term><term>Fistule pancréatique (étiologie)</term><term>Humains (MeSH)</term><term>Pancréatectomie (MeSH)</term><term>Réintervention (MeSH)</term><term>Résultat thérapeutique (MeSH)</term><term>Traitements préservant les organes (MeSH)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Pancreaticoduodenectomy</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Duodénopancréatectomie</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Pancreatic Fistula</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Pancreatic Fistula</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Complications postopératoires</term><term>Fistule pancréatique</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Complications postopératoires</term><term>Fistule pancréatique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Organ Sparing Treatments</term><term>Pancreatectomy</term><term>Reoperation</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Humains</term><term>Pancréatectomie</term><term>Réintervention</term><term>Résultat thérapeutique</term><term>Traitements préservant les organes</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Life-threatening postoperative pancreatic fistula (LTPOPF) is the most feared complication after pancreatoduodenectomy (PD). Although completion pancreatectomy (CP) is usually performed when radiological management fails, the associated morbidity and mortality rates remain high. Here, we reviewed pancreas-preserving alternatives to CP.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>The PubMed database was systematically searched for publications between 1983 and 2014, describing pancreas-preserving surgical treatment of the pancreas remnant (PR) after reintervention in a context of post-PD LTPOPF.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>A total of 12 articles including 140 patients were reviewed. Six different types of pancreas-preserving treatment were described: external wirsungostomy, simple drainage of the PF, closure of pancreatic stump, internal wirsungostomy, partial CP, and salvage pancreatogastrostomy after major leakage of a pancreatojejunostomy. The overall median survival rate was 75 % but rose to 83 % when patients undergoing only surgical drainage of the fistula were excluded. The median complication rate was 75 %, and the median length of hospital stay was 41.5 days. Further reintervention was required for 25 % of the patients. The median incidence of late diabetes was 22.5 %. The incidence of exocrine insufficiency ranged from 0 to 100 % depending on the intervention.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Pancreas-preserving surgical management of the PR after LTPOPF can be performed with acceptable mortality and morbidity. These data suggest that CP should have a more precisely specified role in the management algorithm and should not be performed systematically.</p></div></front></TEI><affiliations><list><country><li>Algérie</li><li>France</li></country><region><li>Hauts-de-France</li><li>Nord-Pas-de-Calais</li><li>Wilaya d'Alger</li></region><settlement><li>Alger</li><li>Béthune</li><li>Lille</li></settlement></list><tree><country name="France"><region name="Hauts-de-France"><name sortKey="Bouras, Ahmed Fouad" sort="Bouras, Ahmed Fouad" uniqKey="Bouras A" first="Ahmed Fouad" last="Bouras">Ahmed Fouad Bouras</name></region><name sortKey="Marin, Helene" sort="Marin, Helene" uniqKey="Marin H" first="Hélène" last="Marin">Hélène Marin</name><name sortKey="Pruvot, Francois Rene" sort="Pruvot, Francois Rene" uniqKey="Pruvot F" first="François-René" last="Pruvot">François-René Pruvot</name><name sortKey="Truant, Stephanie" sort="Truant, Stephanie" uniqKey="Truant S" first="Stéphanie" last="Truant">Stéphanie Truant</name><name sortKey="Zerbib, Philippe" sort="Zerbib, Philippe" uniqKey="Zerbib P" first="Philippe" last="Zerbib">Philippe Zerbib</name></country><country name="Algérie"><region name="Wilaya d'Alger"><name sortKey="Bouzid, Chafik" sort="Bouzid, Chafik" uniqKey="Bouzid C" first="Chafik" last="Bouzid">Chafik Bouzid</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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