Predicting Successful Catheter Drainage in Patients With Pancreatic Fistula After Pancreatoduodenectomy

被引:8
作者
Smits, F. Jasmijn [1 ,2 ]
van Santvoort, Hjalmar C. [1 ,2 ]
Besselink, Marc G. [3 ]
Boerma, Djamila [1 ,2 ]
Busch, Olivier R. [3 ]
van Dam, Ronald M. [4 ]
van Eijck, Casper H. [5 ]
Festen, Sebastiaan [6 ]
van der Harst, Erwin [7 ]
de Hingh, Ignace H. [8 ]
de Jong, Koert P. [9 ]
Rinkes, Inne H. Borel [1 ,2 ]
Molenaar, I. Quintus [1 ,2 ]
机构
[1] Univ Med Ctr Utrecht, Reg Acad Canc Ctr Utrecht, Dept Surg, Utrecht, Netherlands
[2] St Antonius Hosp, Utrecht, Netherlands
[3] Univ Amsterdam, Amsterdam UMC, Canc Ctr Amsterdam, Dept Surg, Amsterdam, Netherlands
[4] Maastricht Univ, Med Ctr, Dept Surg, Maastricht, Netherlands
[5] Erasmus MC, Dept Surg, Rotterdam, Netherlands
[6] Onze Lieve Vrouw Hosp, Dept Surg, Amsterdam, Netherlands
[7] Maasstad Hosp, Dept Surg, Rotterdam, Netherlands
[8] Catharina Hosp, Dept Surg, Eindhoven, Netherlands
[9] Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands
关键词
pancreatic carcinoma; pancreatic leakage; amylase; complication management; multicenter; ADJUVANT CHEMOTHERAPY; INTENSIVE-CARE; GRADE C; CANCER; GEMCITABINE; INTERVENTIONS; MANAGEMENT; PROGNOSIS; MODEL; RISK;
D O I
10.1097/MPA.0000000000001334
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objectives The objective of this study was to identify predictors for successful minimally invasive catheter drainage (ie, survival without relaparotomy) for pancreatic fistula after pancreatoduodenectomy. Methods Included were consecutive patients undergoing catheter drainage as first intervention for pancreatic fistula after pancreatoduodenectomy (2005-2013) in 9 Dutch centers. Possible prognostic factors for successful catheter drainage (ie, survival without relaparotomy) were selected using Akaike information criterion. Results Included were 227 patients after 2196 pancreatoduodenectomies. Primary catheter drainage was successful in 175 (77%) of 227 patients. Multivariable logistic regression revealed the following negative prognostic factors for success: male sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.00; P = 0.049), higher age (for every 5 years over 50; OR, 0.69; 95% CI, 0.57-0.84; P < 0.001), and respiratory failure at time of catheter drainage (OR, 0.10; 95% CI, 0.03-0.33; P < 0.001). A prognostic model incorporating these factors yielded an area under the curve of 0.76 and demonstrated a success range of 98% to 14%. Conclusions Male sex, higher age, and respiratory failure are associated with a low success rate of catheter drainage in patients with pancreatic fistula after pancreatoduodenectomy. These patients might benefit from an intensified postoperative monitoring for early detection and management of pancreatic fistula to prevent respiratory failure.
引用
收藏
页码:811 / 816
页数:6
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