Postoperative Pancreatic Fistula after Pancreaticoduodenectomy: Toward "Zero Pancreatic Fistulas"
Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
Pancreaticoduodenectomy (PD) is the procedure of choice for malignant disorders and certain benign disorders in the pancreaticoduodenal region. Several modifications of the surgical procedure have been proposed for accomplishing radical resection and for improving of quality of life. Pancreatic fistula (PF) is a common, potentially life-threatening postoperative complication of PD. An International Study Group on Pancreatic Fistula defined PF as drain output of any measurable volume of fluid on or after postoperative day 3 with amylase content greater than 3 times the serum amylase activity. This definition grades the severity of PF according to its effect on the clinical course. According to this criterion, about 20% of patients have PF after PD. Of these patients, 10% have grade B or C PF. Soft pancreatic parenchyma, intraoperative blood transfusion, and postoperative bleeding are significant risk factors for PF after PD. Conservative treatment is the treatment of first choice for PF after PD and is extremely effective. However, some patients require additional percutaneous drainage or surgical treatment or both. Uncontrolled sepsis and massive hemorrhage are the main causes of death. Early aggressive interventional embolization allows later conservative management of most patients with intraabdominal hemorrhage and prevents death. Therefore, early recognition of a PF and prompt and appropriate treatment are critical for preventing potentially devastating consequences. On the other hand, little has been done to evaluate the efficacy of tissue engineering for anastomotic healing of pancreaticojejunostomy toward the goal of "Zero PF." We examined the effects of basic fibroblast growth factor incorporated in gelatin hydrogel (bFGF-GH) microspheres on anastomotic healing. Basic FGF-GH administration can promote the rapid completion of pancreaticojejeunal anastomosis and may help improve the quality of healing in granulation tissue by conferring potent angiogenesis and accelerating apoptosis. Basic FGF-GH shows promise as a new technique for preventing PF.
日医大医会誌 2009; 5(4), 193-201
pancreaticoduodenectomy, basic fibroblast growth factor, postoperative pancreatic fistula, tissue engineering, International Study Group on Pancreatic Fistula definition
Takayuki Aimoto, Department of Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan