A Comparative Analysis of Postoperative Pancreatic Fistulas After Surgery With and Without Hyperthermic Intraperitoneal Chemoperfusion

Stephanie Downs-Canner, Ying Ding, Deepa R. Magge, Heather Jones, Lekshmi Ramalingam, Amer Zureikat, Matthew Holtzman, Steven Ahrendt, James Pingpank, Herbert J. Zeh, David L. Bartlett, Haroon A. Choudry

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Postoperative pancreatic fistulas (POPFs) are potentially morbid complications that often require therapeutic interventions. Distal pancreatectomy performed during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) puts patients at risk for POPF. The authors hypothesized that POPFs are more severe after CRS/HIPEC than after pancreatectomy alone. Methods: Clinicopathologic and perioperative details, including POPF by International Study Group of Pancreatic Fistula criteria (ISGPF), and oncologic outcomes for patients undergoing distal pancreatectomy during CRS/HIPEC for peritoneal carcinomatosis of appendiceal (n = 31) or colorectal (n = 23) origin (HIPEC group) were compared with those for patients undergoing minimally invasive or open distal pancreatectomy without HIPEC (n = 66) for locally resectable pancreatic adenocarcinoma (non-HIPEC group). Results: The incidence of POPF was similar between the HIPEC and non-HIPEC groups (26 %). The severity of POPF according to the ISGPF criteria was significantly worse in the HIPEC group. The HIPEC patients had 13 grade B fistulas and 1 grade C fistula compared with 12 grade A fistulas and 4 grade B fistulas in the non-HIPEC group. The HIPEC patients with POPF did not differ in the extent of their CRS, peritoneal cancer index, length of hospital stay, or other postoperative complications from the the HIPEC patients without POPF. The HIPEC patients with colorectal carcinomatosis who experienced POPF had higher disease recurrence in the first year after CRS/HIPEC than those without POPF. Conclusion: The findings showed that POPFs are more severe when distal pancreatectomy is combined with CRS/HIPEC. Moreover, selective use of distal pancreatectomy is important during CRS/HIPEC because POPFs may increase early disease recurrence for patients with colorectal carcinomatosis.

Original languageEnglish (US)
Pages (from-to)1651-1657
Number of pages7
JournalAnnals of Surgical Oncology
Issue number5
StatePublished - May 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oncology


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