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

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Abstract

Pancreaticoduodenal and distal resections are crucial components of pancreatic cancer treatment. Pancreatic fistula is one of the most common complications of these surgeries. The main criterion for the diagnosis of pancreatic fistula is the increase of amylase drain level more than 3 times from the normal 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 of hospital stay. Risk factors for pancreatic fistula can be split in two categories: patient-related and procedure-related. The patient-related risk factors are: male sex, age more than 70 years, small or large 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.

The most effective method for fistula prophylaxis is intraoperative risk evaluation with initial pancreatectomy in case of high risk. 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.

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About the authors

Mikhail B. Potievskiy

National Medical Research Radiological Center

Author for correspondence.
Email: mikhailpotievsky@yandex.ru
ORCID iD: 0000-0002-8514-8295
SPIN-code: 8127-1917
Russian Federation, Obninsk

Leonid O. Petrov

National Medical Research Radiological Center

Email: leonid_petrov@mail.ru
ORCID iD: 0000-0001-6272-9647
SPIN-code: 4559-3613

MD, Cand. Sci. (Medicine)

Russian Federation, Obninsk

Sergei A. Ivanov

National Medical Research Radiological Center

Email: oncourolog@gmail.com
ORCID iD: 0000-0001-7689-6032
SPIN-code: 4264-5167

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

Russian Federation, Obninsk

Pavel V. Sokolov

National Medical Research Radiological Center

Email: sokolov-p-v@yandex.ru
ORCID iD: 0000-0002-5050-7868
SPIN-code: 8527-6278

MD

Russian Federation, Obninsk

Vladimir S. Trifanov

National Medical Research Radiological Center

Email: trifan1975@yandex.ru
ORCID iD: 0000-0003-1879-6978
SPIN-code: 3710-8052

MD, Dr. Sci. (Medicine), Associate Professor

Russian Federation, Obninsk

Nikolai A. Grishin

National Medical Research Radiological Center

Email: grishinlap@mail.ru
ORCID iD: 0000-0003-1703-9115
SPIN-code: 4707-7941

MD, Cand. Sci. (Medicine)

Russian Federation, Obninsk

Ruslan I. Moshurov

National Medical Research Radiological Center

Email: ruslan4ic93@mail.ru
ORCID iD: 0000-0002-5676-4224
SPIN-code: 2134-1092

MD, Cand. Sci. (Medicine)

Russian Federation, Obninsk

Lidia A. Nekrasova

National Medical Research Radiological Center

Email: Lida_n@mail.ru
ORCID iD: 0009-0001-2348-0831

MD

Russian Federation, Obninsk

Petr V. Shegai

National Medical Research Radiological Center

Email: dr.shegai@mail.ru
ORCID iD: 0000-0001-9755-1164
SPIN-code: 6849-3221

MD, Cand. Sci. (Medicine)

Russian Federation, Obninsk

Andrei D. Kaprin

National Medical Research Radiological Center

Email: kaprin@mail.ru
ORCID iD: 0000-0001-8784-8415
SPIN-code: 1759-8101

MD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences

Russian Federation, Obninsk

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