| Part 1: Evaluation and prediction of the risk of pancreatic fistula after pancreaticoduodenectomyObjective: Aimed to explore the risk factors of pancreatic fistula after pancreaticoduodenectomy and predict the occurrence of pancreatic fistula through retrospective analyzing the complications and related laboratory tests during the early postoperative period.We hope to adopt different clinical treatment strategies for patients with different risks of pancreatic fistula to achieve the purpose of individualized treatment.Methods: We retrospective analysis of 201 patients who underwent PD in our hospital from January 1,2017 to August 1,2019.The preoperative,intraoperative and postoperative information and laboratory tests were detailed records.According to the International Study Group Of Pancreatic Surgery(ISGPS 2016)pancreatic fistula grading system and Clavien-Dindo complication grading system,the study subjects were divided into pancreatic fistula group,non-pancreatic fistula group;light grade B pancreatic fistula group and severe grade B pancreatic fistula group;The light complication group and the severe complication group.We analyzed the risk factors of pancreatic fistula after pancreaticoduodenectomy and the predictive effect of related laboratory indicators in different groups on pancreatic fistula and other complications.Results: Of the 201 patients included in our study,47 patients developed pancreatic fistula,and the incidence of pancreatic fistula was 23.4%,of which 46 were grade B pancreatic fistula and 1 was grade C pancreatic fistula.The study subjects were divided into pancreatic fistula group and non-pancreatic fistula group.The univariate analysis showed that the incidence of pancreatic fistula after PD was related to the preoperative BMI index,pancreatic texture and pancreatic duct diameter.Multivariate analysis results shows that the preoperative BMI index ≥21.1 kg / m2(OR = 4.633,95% CI: 1.903-11.282,P = 0.001)and the texture of the pancreas soft(OR = 4.489,95% CI: 1.490-13.519,P = 0.008)and pancreatic duct diameter <3mm(OR = 2.717,95% CI: 1.057-6.987,P = 0.038)are independent risk factors for pancreatic fistula after pancreaticoduodenectomy.Analysis of laboratory tests on the first day showed that CRP,platelets count,and CAR values of the pancreatic fistula group and non-pancreatic fistula group were statistically different(P <0.05).CRP,platelets count,and CAR can effectively predict the occurrence of clinically relevant pancreatic fistula after PD.Multivariate analysis results showed that CRP ≥89.4mg / L(OR = 10.786,95% CI 4.807-24.204,P = 0.000)and platelets ≥176 * 109 / L(OR = 4.483,95% CI 1.903-10.560,P = 0.001)are independent risk factors for the development of clinically relevant pancreatic fistula.Analysis of laboratory tests on the third day showed that CRP,CAR,serum prealbumin,and △ CRP were statistically different between the pancreatic fistula group and the non-pancreatic fistula group.CRP,CAR,serum prealbumin and △ CRP(POD3-POD1)can effectively predict the occurrence of clinically relevant pancreatic fistula after PD.Multivariate analysis showed that CRP ≥147.5 mg / L(OR = 6.110,95% CI 2.413-15.471,P = 0.000)and prealbumin <100 mg / L(OR = 3.188,95% CI 1.460)-6.957,P = 0.004)and platelets ≥157 * 109 / L(OR = 2.343,95% CI 1.075-5.107,P = 0.032)are independent risk factors for the occurrence of clinically relevant pancreatic fistula.Then we divided the subjects into light grade B pancreatic fistula group(B1 group: 17 cases)and severe grade B pancreatic fistula group(B2 group: 29 cases).The analysis shows that there was a statistical difference in the length of stay in hospital,incidence of abdominal collections,abdominal infection,total incidence of other complications(P <0.05).The results on POD1 shows that CRP,CAR and Urea Nitrogen were statistically different between the non-POPF+B1 group and B2 groups(P <0.05).CRP and CAR can effectively predict postoperative occurrence of severe grade B pancreatic fistula.Multivariate analysis showed that CRP≥89.4 mg/L(OR=4.387,95% CI 1.854-10.383,P=0.001)and Urea Nitrogen≥4.87mmol/L(OR=2.830,95% CI 1.187-6.749,P=0.019)are independent risk factors for the occurrence of severe grade B pancreatic fistula.The results on POD3 shows that CRP、 PLR、CAR、serum prealbumin and △CRP were statistically different between the non-POPF+B1 group and B2 groups(P <0.05).CRP、 CAR、serum prealbumin and △CRP can effectively predict postoperative occurrence of severe grade B pancreatic fistula.Multivariate analysis showed that CRP≥147.5 mg/L(OR=8.156,95% CI 2.073-32.092,P=0.003)、PLR≥238.7(OR=4.265,95% CI 1.588-11.457,P=0.004)and ΔCRP≥114.5 mg/L(OR=3.982,95% CI 1.362-11.642,P=0.012)are independent risk factors for the occurrence of severe grade B pancreatic fistula.According to the Clavien-Dindo classification system,patients were divided into complications ≤Grade 2 group(167 cases)and ≥Grade 3 groups(34 cases).The results on POD1 shows that CRP and CAR were statistically different between the complications ≤Grade 2 group and ≥Grade 3 groups(P <0.05).CRP and CAR can effectively predict postoperative occurrence of severe complications.The results on POD3 shows that CRP、CAR 、serum prealbumin and △CRP were statistically different between the complications ≤Grade 2 group and ≥Grade 3 groups(P <0.05).CRP、CAR and serum prealbumin can effectively predict postoperative occurrence of severe complications.Multivariate analysis showed that CRP≥143.8 mg/L(OR=8.740,95% CI 2.690-28.389,P=0.000)and albumin<36.1 g/L(OR=2.916,95% CI 1.099-7.733,P=0.032)are independent risk factors for the occurrence of severe complications.Conclusions: Preoperative BMI index ≥21.1 kg/m2,the pancreatic texture is soft,pancreatic duct diameter <3mm are independent risk factors for pancreatic fistula after pancreatoduodenectomy.Early laboratory tests can effectively predict the occurrence of clinically relevant pancreatic fistula,grade B severe pancreatic fistula,and severe postoperative complications.Part 2: Systematic review and meta-analysis of octreotide in preventing postoperative complications after pancreatic resectionObjective: The use of octreotide prophylaxis following pancreatic surgery is controversial.We aimed to evaluate the effectiveness of octreotide for the prevention of postoperative complications after pancreatic surgery through this systematic review and meta-analysis.Methods: Literature databases(including the MEDLINE,EMBASE and Cochrane databases)were searched systematically for relevant articles.Only randomized controlled trials(RCTs)were eligible for inclusion in our research.We extracted the basic information regarding the patients,intervention procedures and all complications after pancreatic surgery and then performed the meta-analysis.Results: Thirteen RCTs involving 2006 patients were identified.There were no differences between the octreotide group and the placebo group with regard to pancreatic fistulas(PFs)(relative risk(RR)=0.79,95% confidence interval(CI)=0.62-0.99,P=0.05),clinically significant PFs(RR=1.01,95% CI=0.68-1.50,P=0.95),mortality(RR=1.21,95% CI=0.78-1.88,P=0.40),biliary leakage(RR 0.84,95% CI=0.39-1.82,P=0.66),delayed gastric emptying(RR=0.83,95% CI=0.54-1.27,P=0.39),abdominal infection(RR=1.00,95% CI= 0.66-1.52,P=1.00),bleeding(RR=1.16,95% CI=0.78-1.72,P=0.46),pulmonary complications(RR=0.73,95% CI=0.45-1.18,P=0.20),overall complications(RR= 0.80,95% CI=0.64-1.01,P=0.06)and re-operation rates(RR=1.18,95% CI= 0.77-1.81,P=0.45).In the high-risk group,octreotide was no more effective at reducing PF formation than placebo(RR=0.81,95% CI=0.67-1.00,P=0.05).In addition,octreotide had no influence on the incidence of PF(RR=0.38,95% CI=0.14-1.05,P=0.06)after distal pancreatic resection and local pancreatic resection.Conclusion: The present best evidence suggests that prophylactic use of octreotide has no effect on reducing complications after pancreatic resection. |
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