Avinash Sewpaul, Yasser Farooque, Stuart Robinson, Gourab Sen, Jeremy Jules French, Steven White, Derek Manas, Richard Charnley, Bryon Jaques
Objective Pancreatic leak following pancreaticoduodenectomy has a major impact on postoperative morbidity. There is however, very little data on the impact of a pancreatic leak on long-term survival following pancreaticoduodenectomy for cancer. The aim of this study was to analyse the impact of pancreatic leak/post-operative pancreatic fistula on survival in patients who underwent a pancreaticoduodenectomy for ampullary, distal cholangiocarcinoma or pancreatic ductal adenocarcinoma. Methods Prospectively collected data from 451 patients undergoing pancreaticoduodenectomy resections from 01 January 2002 - 31 December 2013 were examined. The survival of patients with and without leaks were compared using Kaplan-Meier curves and significance was measured using log-rank (Mantel-Cox). Other well-known prognostic factors after resection for the 3 histological subgroups were also investigated. Results 94 of the 451 patients had a post-operative pancreatic fistula giving an overall pancreatic anastomotic leak rate of 20.8%. The median follow-up was 23 months. A pancreatic leak/post-operative pancreatic fistula did not appear to have a detrimental effect on survival as demonstrated by Kaplan Meir survival curves in all of the 3 histological subgroups. Conclusion Our study seems to corroborate the findings of others, in that a postoperative pancreatic fistula does not seem to have a negative impact on patients’ long-term survival. This appears to apply not only to pancreatic ductal cancers, but also to ampullary adenocarcinomas and distal cholangiocarcinomas.
