ABSTRACT
Prevention and surgical treatment of postoperative pancreatic fistula
Postoperative pancreatic fistula (POPF) continues to be the most challenging and frequent complication of pancreatic surgery, particularly after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). This review summarizes the recent advances in the research of risk factors, predictive models, prevention strategies and treatment options. The major risk factors include soft pancreatic texture, small pancreatic duct diameter, high BMI, and excessive retroperitoneal fat. Several risk models have been developed, such as FRS, a-FRS, ua-FRS, and the recently validated D-FRS, to stratify patients and guide their perioperative management. Preventive measures focus on the optimal choice of anastomotic modalities (e.g. the modified Blumgart method), the use of stump coverage in DP, selective drainage and pharmacological agents such as somatostatin analogs. However, recent trials have not confirmed the routine efficacy of octreotide or pasireotide in reducing clinically relevant POPF (CR-POPF). Treatment of POPF should be individualized according to the ISGPS classification. Type B fistulas typically respond to conservative management involving the use of drainage, antibiotics, and nutritional support. In contrast, type C fistulas may require surgical intervention. Pancreas-preserving procedures are associated with a lower mortality than pancreatectomy and are the preferred option whenever considered feasible. Interdisciplinary cooperation and early identification of complications are the key to improving treatment outcomes. The clinical significance of these findings lies in the need for individualized and multidisciplinary pathways involving preoperative risk assessment, optimized surgical methods, and postoperative surveillance to minimize morbidity and mortality due to POPF.
Piśmiennictwo
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