ArticleLangenbeck's archives of surgery2026
Stereotactic body radiotherapy as a rescue modality for definitive treatment of therapy-refractory fistulas after pancreatic surgery.
Article in Langenbeck's archives of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePostoperative pancreatic fistula (POPF) Grade B/C, according to ISGPS 2016 criteria, poses a significant challenge due to severe complications such as sepsis, hemorrhage, and organ failure. When standard treatments are unsuccessful, treatment options become limited. This series investigates the use of MR-guided stereotactic body radiotherapy (SBRT) as a potential rescue therapy for refractory POPF. MATERIALS AND
methodsBetween 2020 and 2025, five patients with refractory Grade B/C POPF and severe complications—including sepsis, abscesses, superinfection, or high-output fistulas—received MR-guided SBRT after failing conventional approaches. The treatment comprised 5 fractions of 4–8 Gy each. Success was defined as the permanent removal of drainage without any subsequent deterioration.
resultsAll five patients were male, with surgical procedures including proximal (n = 1), distal pancreatic resection (n = 3), or necrosectomy (n = 1). The median drain output significantly decreased from 47.5 ml/day to 2 ml/day. Drains were removed after a median of 44 days. No gastrointestinal toxicity was observed; only one patient reported mild fatigue. The interval until rehospitalization markedly decreased from a median of 14 days pre-treatment to zero days post-treatment. Rehospitalizations before SBRT were caused by abscesses or drain malfunctions, but none occurred afterward.
conclusionThis is the first series to evaluate MR-guided SBRT as a treatment for refractory POPF. The findings suggest that this non-invasive approach could reduce morbidity and offers a promising alternative when traditional methods fail. Further research with larger cohorts is necessary to confirm these outcomes.
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