The problem of pancreatic fistula development after pancreatic surgery in oncological patients

Abstract

Pancreaticoduodenal and distal resections considered crucial components of pancreatic cancer treatment. Pancreatic fistula is one of the most common complications these surgeries. The main criterion for the diagnosis of pancreatic fistula is the increase of amylase drain level more than 3 norms of the blood level. Pancreatic fistulas worsen the long-term results of cancer treatment and increase the risk of bleeding per an erosion of visceral vessels, pancreatitis and peritonitis, as well as increase the duration hospitalization. Risk factors for pancreatic fistula may be distinguished into patient-related and surgical factors. The patient-related factors are male sex, age more than 70 years, small diameter of the pancreatic duct, epithelial type of the malignancy, comorbidities and a high volume of drainage fluid in the postoperative period. Surgical risk factors are the severity of intraoperative blood loss, soft pancreas, duration of surgery and surgical techniques. At the same time, it is possible to use medical glues and pharmacological methods for prevention and treatment of postoperative pancreatic fistulas, but further investigations are required. Thus, prevention and treatment of postoperative pancreatic fistulas is a crucial component of management of patients who undergo surgery for pancreatic malignancies.