Evidence map›Paper›PMID 30887293›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2019

The Effect of Pancreaticojejunostomy Technique on Fistula Formation Following Pancreaticoduodenectomy in the Soft Pancreas.

Lisbi Rivas, Sara L Zettervall, Tammy Ju, Samantha Olafson, Jeremy Holzmacher, Paul P Lin, Khashayar Vaziri

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Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Lisbi RivasDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA. lrivas@gwu.edu.ORCID 0000-0002-9505-2334
Sara L ZettervallDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA.
Tammy JuDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA.
Samantha OlafsonDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA.
Jeremy HolzmacherDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA.
Paul P LinDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA.
Khashayar VaziriDepartment of Surgery, George Washington University Medical Center, Washington, DC, USA.
George Washington University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionA soft pancreas has been associated with an increased risk of post-operative pancreatic fistula formation. Few studies have evaluated the effect of anastomotic technique (duct to mucosa vs invagination) on fistula formation. This study aims to compare the effect of anastomotic technique on fistula formation among patients with a soft pancreas in a large multiinstitutional database.

methodsThe targeted pancreas module of the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) Database was used. All patients with a soft pancreas who underwent pancreaticoduodenectomy from 2014 to 2015 were identified. Demographic data, comorbid conditions, operative variables, and 30-day outcomes were compared using univariate and multivariable analyses.

resultsA total of 975 patients met inclusion criteria. Eight-hundred fifty four (88%) underwent a duct to mucosa pancreaticojejunostomy technique and 121 (12%) underwent invagination. Patients who underwent invagination had higher 30-day mortality (5.8% vs 1.4%, p < 0.01), higher fistula formation (38% vs 25%, p < 0.01), and more often had percutaneous drain placement post-operatively (27% vs 14%, p < 0.01). Following multivariable analysis, invagination remained associated with pancreatic fistula formation (OR 2.5, CI 1.4-4.3) and post-operative percutaneous drain placement (OR 1.8, CI 1.1-2.9).

conclusionInvagination technique for pancreaticojejunostomy in patients with a soft pancreas is associated with increased rates of pancreatic fistula. Surgeons should consider utilizing a duct to mucosa technique when feasible to decrease morbidity following pancreaticoduodenectomy in this patient population.

Indexed as

Postoperative ComplicationsQuality ImprovementFemaleHumansIncidenceMaleMiddle AgedPancreasPancreatic FistulaPancreaticoduodenectomyPancreaticojejunostomyUnited StatesNSQIPPancreaticojejunostomyPost-operative pancreatic fistula

Identifiers

PMID30887293
OpenAlexW2921559678

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.