Early Aggressive Management of Postoperative Pancreatic Fistulas following Pancreaticoduodenectomy (PD): A Five-Year Single Institution Experience

Background: Pancreatico-duodenectomy for pancreatic tumours remains the standard of care. Morbidity rates are still high, often as a result of post-operative pancreatic fistulae (POPF), leading to prolonged hospital stays and increased costs. At our institute we treat all pancreatic fistulas defined by ISGPF criteria with parenteral nutrition and an octreotide infusion for a minimum of 7 days. Our experience suggests that early and aggressive management of POPF could prevent Grade C fistulas. Methods: We retrospectively analysed the data that underwent PD between 2013-2017. We reviewed for all patients who experienced Grade B POPF. Data included details of total parenteral nutrition received, dose of octreotide infusion administered, serial drain amylase levels, effluent volume and anthropometry. Outcome measures were weight changes associated with treatment, the number of lines used per patient, the length of treatment, treatment associated complications and 90-day mortality rates. Results: 53 patients had a Grade B POPF and all were treated with the ‘leak protocol’. The Grade B pancreatic fistulas rate was 13%. Median ages of the patients were 69. Median hospital stay was 30.5 days. Parenteral nutrition was administered for an average of 20 days. The mean BMI on discharge was 26.5 with an average weight difference of -4.9%. There was one 90-day operative mortality. 2 patients had Grade C fistulas requiring re-operation. Conclusions: Our institutional practice has good results with a Grade C POPF incidence of 0.4% that is much lower than what is in literature. We think this management of pancreatic leaks have promising results.