Toward defining grade C pancreatic fistula following pancreaticoduodenectomy: Incidence, risk factors, management and outcome

Jason W. Denbo, W. Shannon Orr, Ben L. Zarzaur, Stephen W. Behrman

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Background: In 2005 the International Study Group for Pancreatic Fistula (ISGPF) created a definition and grading system for pancreatic fistulae (PF) in which grade C denotes the most severe and potentially life-threatening type. Factors and outcomes associated with grade C fistulae have been ill defined. Methods: Systematic searches of PubMed and EMBASE were conducted by two independent reviewers utilizing the keywords 'pancreaticoduodenectomy' (PD) and 'pancreatic fistula'. Inclusion criteria were: (i) a sample of ≥100 patients; (ii) consecutive accrual of all pathologies, and (iii) use of the ISGPF definition and grading system. Quality appraisal and data extraction were performed using pilot-tested templates. Results: Fourteen articles describing a total of 2706 PDs met the study entrance criteria. Pancreatic fistulae occurred in 479 patients (18%) and included 71 grade C PF that were directly responsible for 25 deaths (35% mortality rate). Only two studies analysed risk factors; these found soft pancreatic texture and histology other than adenocarcinoma to be the most common risk factors. Ten studies reported management strategies and indicated that 51% of patients required reoperation. Conclusions: Grade C PF: (i) accounts for 15% of fistulae following PD and has an associated mortality rate of 35%; (ii) occurs most commonly in pathology associated with a soft remnant, and (iii) requires reoperation in approximately one half of patients. The published literature incompletely describes grade C PF.

Original languageEnglish (US)
Pages (from-to)589-593
Number of pages5
Issue number9
StatePublished - Sep 2012

Bibliographical note

Funding Information:
This study was supported in part by the Herb Kosten Endowment Fund for Pancreatic Cancer Research and Care at the University of Tennessee Health Science Center.

Copyright 2017 Elsevier B.V., All rights reserved.


  • morbidity
  • mortality
  • neoplasia
  • outcome
  • pancreas
  • resection


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