• J V Groen, F J Smits, D Koole, M G Besselink, O R Busch, M den Dulk, van EijckC H JCHJDepartment of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands., B Groot Koerkamp, E van der Harst, I H de Hingh, T M Karsten, V E de Meijer, B K Pranger, I Q Molenaar, B A Bonsing, H C van Santvoort, J S D Mieog, and Dutch Pancreatic Cancer Group.
• Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
• Br J Surg. 2021 Nov 11; 108 (11): 137113791371-1379.

BackgroundDespite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy.MethodsThis retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines.ResultsFrom 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P = 0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24 h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P = 0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84).ConclusionBased on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

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