Timme et al evaluated risk factors for pancreatic fistula following pancreatoduodenectomy. These can help to identify a patient who may require more aggressive management. The authors are from the University of Freiburg, University Medical Center Schleswig-Holstein and Semmelweis University in Budapest.
Patient selection: status post pancreatoduodenectomy
Parameters:
(1) sex of the patient
(2) surgeon annual volume for pancreatoduodenectomies
(3) pancreatic texture
(4) histologic fibrosis of the pancreas
(4) renal comorbidity
Parameter
Finding
Odds Ratio
sex
female
1
male
3.122
surgeon volume
< 10
1
10 to 25
0.262
> 25
0.187
pancreatic texture
soft
2.754
firm
1
histologic fibrosis
HPF 0 (none)
1
HPF I (mild)
0.237
HPF 2 (moderate)
0.117
HPF 3 (severe with architectural destruction)
0.078
renal comorbidity
no
1
yes
0.271 (p value 0.138)
The authors postulated that fibrosis grading at the time of surgery by frozen section could help to guide management to reduce the risk.
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