Fluid collection and pancreatic fistula after pancreaticoduodenectomy

• Published in: Acta Medica Nagasakiensia Vol. 66; no. 1; pp. 29 - 34
• Main Authors: Kuroki, Tamotsu, Okamoto, Tatsuya, Kitasato, Amane, Miyoshi, Takayuki, Yoneda, Akira, Takeshita, Hiroaki
• Format: Journal Article
• Language: English
• Published: Nagasaki University School of Medicine 03.10.2022
• Subjects: Fluid collection; pancreatic fistula; pancreaticoduodenectomy; triple-drug therapy
• ISSN: 0001-6055
• DOI: 10.11343/amn.66.29

Background: Although postoperative abdominal fluid collection (POFC) is an important predictive factor for clinically relevant postoperative pancreatic fistula (CR-POPF), many patients are asymptomatic and resolve spontaneously. Triple-drug therapy consisting of gabexate mesylate, octreotide, and carbapenem antibiotics has been used at our institution to prevent pancreatic fistula after pancreatectomy. The present study aimed to evaluate the management and outcomes of patients with POFC and to determine the efficacy of triple-drug therapy to prevent CR-POPF after pancreaticoduodenectomy (PD).Methods: From 2016 to 2021, 125 patients who underwent PD were retrospectively analyzed to determine their postoperative fluid collection status. Triple-drug therapy was administered to patients who showed high amylase levels in their drainage (>10,000 IU/L) on POD 1, 3, or 5, and who had any clinical symptoms associated with POFC.Results: The overall rate of POFC was 26% (n=33). Among these patients, CR-POPF developed in 16 patients (48%). There was no CR-POPF patient in the NO-POFC patient group. Triple-drug therapy was performed for 30 patients according to a preexisting treatment algorithm. Among these 30 patients, there were 23 POFC and 7 No-POFC patients. Twelve (52%) of the POFC patients developed CR-POPF despite treatment with triple-drug therapy. There were no CR-POPF patients in the No-POFC patient group.Conclusions: Although POFC after PD is an important finding for CR-POPF, it does not necessarily develop into CR-POPF. The administration of triple-drug therapy is effective for the prevention of CR-POPF in cases without POFC fluid drainage as well as in those with POFC.