Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis

J.V. Groen; F.J. Smits; D. Koole; M.G. Besselink; O.R. Busch; M. den Dulk; C.H.J. van Eijck; B.G. Koerkamp; E. van der Harst; I.H. de Hingh; T.M. Karsten; V.E. de Meijer; B.K. Pranger; I.Q. Molenaar; B.A. Bonsing; H.C. van Santvoort; J.S.D. Mieog; Dutch Pancreatic Canc Grp

doi:10.1093/bjs/znab273

Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis

J.V. Groen^*, F.J. Smits, D. Koole, M.G. Besselink, O.R. Busch, M. den Dulk, C.H.J. van Eijck, B.G. Koerkamp, E. van der Harst, I.H. de Hingh, T.M. Karsten, V.E. de Meijer, B.K. Pranger, I.Q. Molenaar, B.A. Bonsing, H.C. van Santvoort, J.S.D. Mieog, Dutch Pancreatic Canc Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy.Methods: This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines.Results: From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P=0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P=0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84).Conclusion: Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.

Original language	English
Pages (from-to)	1371-1379
Number of pages	9
Journal	British Journal of Surgery
Volume	108
Issue number	11
DOIs	https://doi.org/10.1093/bjs/znab273
Publication status	Published - 1 Nov 2021

Keywords

INTERNATIONAL STUDY-GROUP
GRADE-C
CONSERVATIVE TREATMENT
SALVAGE PROCEDURE
ANASTOMOTIC LEAK
DAMAGE CONTROL
MANAGEMENT
SURGERY
RESECTION
PANCREATOGASTROSTOMY

Access to Document

10.1093/bjs/znab273Licence: CC BY-NC

Cite this

Groen, J. V., Smits, F. J., Koole, D., Besselink, M. G., Busch, O. R., den Dulk, M., van Eijck, C. H. J., Koerkamp, B. G., van der Harst, E., de Hingh, I. H., Karsten, T. M., de Meijer, V. E., Pranger, B. K., Molenaar, I. Q., Bonsing, B. A., van Santvoort, H. C., Mieog, J. S. D., & Dutch Pancreatic Canc Grp (2021). Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis. British Journal of Surgery, 108(11), 1371-1379. https://doi.org/10.1093/bjs/znab273

@article{f441151f8786426a8131c3a741246030,

title = "Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis",

abstract = "Background: Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy.Methods: This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines.Results: From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P=0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P=0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84).Conclusion: Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.",

keywords = "INTERNATIONAL STUDY-GROUP, GRADE-C, CONSERVATIVE TREATMENT, SALVAGE PROCEDURE, ANASTOMOTIC LEAK, DAMAGE CONTROL, MANAGEMENT, SURGERY, RESECTION, PANCREATOGASTROSTOMY",

author = "J.V. Groen and F.J. Smits and D. Koole and M.G. Besselink and O.R. Busch and {den Dulk}, M. and {van Eijck}, C.H.J. and B.G. Koerkamp and {van der Harst}, E. and {de Hingh}, I.H. and T.M. Karsten and {de Meijer}, V.E. and B.K. Pranger and I.Q. Molenaar and B.A. Bonsing and {van Santvoort}, H.C. and J.S.D. Mieog and {Dutch Pancreatic Canc Grp}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2021",

month = nov,

day = "1",

doi = "10.1093/bjs/znab273",

language = "English",

volume = "108",

pages = "1371--1379",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Wiley",

number = "11",

}

Groen, JV, Smits, FJ, Koole, D, Besselink, MG, Busch, OR, den Dulk, M, van Eijck, CHJ, Koerkamp, BG, van der Harst, E, de Hingh, IH, Karsten, TM, de Meijer, VE, Pranger, BK, Molenaar, IQ, Bonsing, BA, van Santvoort, HC, Mieog, JSD & Dutch Pancreatic Canc Grp 2021, 'Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis', British Journal of Surgery, vol. 108, no. 11, pp. 1371-1379. https://doi.org/10.1093/bjs/znab273

Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis. / Groen, J.V.; Smits, F.J.; Koole, D. et al.
In: British Journal of Surgery, Vol. 108, No. 11, 01.11.2021, p. 1371-1379.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis

AU - Groen, J.V.

AU - Smits, F.J.

AU - Koole, D.

AU - Besselink, M.G.

AU - Busch, O.R.

AU - den Dulk, M.

AU - van Eijck, C.H.J.

AU - Koerkamp, B.G.

AU - van der Harst, E.

AU - de Hingh, I.H.

AU - Karsten, T.M.

AU - de Meijer, V.E.

AU - Pranger, B.K.

AU - Molenaar, I.Q.

AU - Bonsing, B.A.

AU - van Santvoort, H.C.

AU - Mieog, J.S.D.

AU - Dutch Pancreatic Canc Grp

PY - 2021/11/1

Y1 - 2021/11/1

N2 - Background: Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy.Methods: This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines.Results: From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P=0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P=0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84).Conclusion: Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.

AB - Background: Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy.Methods: This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines.Results: From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P=0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P=0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84).Conclusion: Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.

KW - INTERNATIONAL STUDY-GROUP

KW - GRADE-C

KW - CONSERVATIVE TREATMENT

KW - SALVAGE PROCEDURE

KW - ANASTOMOTIC LEAK

KW - DAMAGE CONTROL

KW - MANAGEMENT

KW - SURGERY

KW - RESECTION

KW - PANCREATOGASTROSTOMY

U2 - 10.1093/bjs/znab273

DO - 10.1093/bjs/znab273

M3 - Article

C2 - 34608941

SN - 0007-1323

VL - 108

SP - 1371

EP - 1379

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 11

ER -