Open AccessRate of Clinically Significant Postoperative Pancreatic Fistula in Pancreatic Neuroendocrine Tumors
Author(s) -
Inchauste Suzanne M.,
Lanier Brock J.,
Libutti Steven K.,
Phan Giao Q.,
Nilubol Naris,
Steinberg Seth M.,
Kebebew Electron,
Hughes Marybeth S.
Publication year - 2012
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-012-1598-9
Subject(s) - medicine , pancreatic fistula , enucleation , pancreaticoduodenectomy , surgery , neuroendocrine tumors , gastroenterology , pancreas
Background In 2005, the International Study Group of Pancreatic Fistula (ISGPF) developed a definition and grading system for postoperative pancreatic fistula (POPF). The authors sought to determine the rate of POPF after enucleation and/or resection of pancreatic neuroendocrine tumors (PNET) and to identify clinical, surgical, or pathologic factors associated with POPF. Methods A retrospective analysis of pancreatic enucleations and resections performed from March 1998 to April 2010. We defined a clinically significant POPF as a grade B that required nonoperative intervention and grade C. Results One hundred twenty‐two patients were identified; 62 patients had enucleations and 60 patients had resections of PNET. The rate of clinically significant POPF was 23.7 % (29/122). For pancreatic enucleation, the POPF rate was 27.4 % (17/62, 14 grade B, 3 grade C). The pancreatic resection group had a POPF rate of 20 % (12/60, 10 grade B, 2 grade C). This difference was not significant ( p = 0.4). In univariate analyses, patients in the enucleation group with hereditary syndromes ( p = 0.02) and non‐insulinoma tumors ( p = 0.02) had a higher POPF rate. Patients in the resection group with body mass index (BMI) > 25 ( p < 0.01), multiple endocrine neoplasia type 1 (MEN‐1; p < 0.01) and those who underwent simultaneous multiple procedures ( p = 0.02) had a higher POPF rate. Multivariate analyses revealed that hereditary syndromes were able to predict POPF in the enucleation group, while having BMI > 25 and increasing lesion size were also associated with POPF in the group undergoing resection. Conclusions We found a clinically significant POPF rate after surgery in PNET to be 23.7 % with no difference by the type of operation. Our POPF rate is comparable to that reported in the literature for pancreatic resection for other types of tumors. Certain inherited genetic diseases—von Hippel–Lindau disease (VHL) and MEN‐1—were associated with higher POPF rates.