KMID : 1188520190150010019
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Korean Journal of Clinical Oncology 2019 Volume.15 No. 1 p.19 ~ p.26
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Single institute experience of pancreatico-enteric anastomosis failure after pancreaticoduodenectomy
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Woo Yoon-kyung
You Young-Kyoung Han Jae-Hyun Choi Ho-Joong Kim Yu-Mi Kwak Bong-Jun Hong Tae-Ho Kim Dong-Goo
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Abstract
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Purpose: We have summarized the experience of our institution related to what treatment has been performed in patients with pancreatic fistula and their outcome.
Methods: Seventy-eight pancreatico-enteric anastomosis failure (PEAF) patients of 403 pancreaticoduodenectomy (PD) were included for this retrospective study. PEAF was defined by the presence of rich amylase (over 10,000 IU/L) in drainage fluid at postoperative day 5 to 7 and radiographic demonstration of the anastomotic breakdown and associated local fluid collection. The management was analyzed by observation group (O group), intervention (I group) and surgery group (S group).
Results: Preoperative clinical status of the PEAF group and non-PEAF group was similar. Bile duct cancer was the highest risk subgroup of the PEAF (P=0.001) and the pancreatic adenocarcinoma showed the least risk for the PEAF (P<0.001). Among the 78 PEAF patients, 50 were managed as a conservative treatment, 15 patients were received radiologic intervention and 13 patients performed rescue surgery. Among these three subgroups, there was no statistical significance in the patient¡¯s demographics, clinical status, surgical factors and disease nature. However, mortality was significantly higher in the S group (P<0.001). The mortality cases were developed one and six patients in O and S group, respectively. Surgical procedures in S group were completion total pancreatectomy with or without splenectomy (n=12) and pancreatectomy preserving spleen in four (28.6%). Pancreaticogastrostomy repair and Roux-en-Y pancreaticojejunostomy reconstruction were performed each case, respectively.
Conclusion: Proper drainage catheter indwelling during the PD or postoperative radiological intervention can effectively manage the PEAF without surgical interventional treatment.
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KEYWORD
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Pancreaticoduodenectomy, Pancreaticojejunostomy, Pancreaticogastrostomy, Pancreatic fistulaReceived
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