An evidence-based approach to the surgical interventions for severe pancreatic fistula after pancreatoduodenectomy

Abstract

Background and objective: To assess the safety and therapeutic outcome of different surgical interventions for severe pancreatic fistula after pancreatoduodenectomy.

Methods: A systematic literature search was performed in PubMed database for relevant articles published between 1990 and March 2017. Descriptive statistics were performed and data are expressed as mean.

Results: Twenty-four studies involving 370 patients undergoing surgical interventions for severe pancreatic fistula after pancreatoduodenectomy were included. Rates of further relaparotomy, in-hospital mortality, and long-term endocrine insufficiency were reported for completion pancreatectomy (31.8%, 42% and 100% respectively), disconnection of anastomosis with preservation of a pancreatic remnant (25%, 21.3% and 17.8% respectively), internal or external wirsungostomy (10.4%, 14.9%, and 12.3% respectively), salvage pancreaticogastrostomy (12.5%, 0% and 25%, respectively), and simple peripancreatic drainage (30%, 47.9% and 12.5%, respectively).

Conclusions: The pancreas-preserving strategy of disconnection of anastomosis with preservation of a pancreatic remnant, internal or external wirsungostomy, and salvage pancreatogastrostomy seems to be the preferred option for the treatment of severe pancreatic fistula after pancreatoduodenectomy. As completion pancreatectomy is a very aggressive treatment, it should only be reserved for specific instances in which organ-preserving resection is technically unfeasible.

Keywords: Completion pancreatectomy; Pancreatic fistula; Pancreatoduodenectomy.