BACKGROUND The most hazardous complication to pancreatic surgery is the development of a post-operative pancreatic fistula (POPF). Appropriate understanding of the underlying pathophysiology, risk factors and perioperative mechanisms may allow for better management and use of preventive measures. METHODS Systematic literature search using the English PubMed literature up to April 2019, with emphasis on the past 5 years. RESULTS Several risk scores have been developed but none are perfect in predicting POPF risk. A conceptual framework of factors that contribute to the pathophysiology of pancreatic fistulae is still developing but incomplete. Recognized factors include those related to the patient, the pathology and the perioperative care. Interventions such as use of drains, stents and various drugs to mediate risk is still debated. Emerging data suggest that both the microbiome and the inflammation in the post-operative phase may play important roles in risk for POPF. Available risk scores allow for stratification of risk and mitigation strategies tailored to reduce this. However, accurate estimation of risk remains a challenge and mechanisms are only partially understood. CONCLUSIONS The pathophysiology of POPF remains poorly understood. Current models only partially explain risks or associated mechanisms. Novel areas of investigation need to be explored for better prediction.

中文翻译：

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胰腺手术后胰瘘发展的术前，围手术期和术后因素。

背景技术对于胰腺手术而言，最危险的并发症是术后胰瘘（POPF）的发展。对潜在的病理生理学，危险因素和围手术期机制的适当理解可能有助于更好地管理和使用预防措施。方法截至2019年4月，使用英语PubMed文献进行系统的文献检索，重点是过去5年。结果已经开发了几个风险评分，但是没有一个完美的预测POPF风险的评分。影响胰瘘病理生理的因素的概念框架仍在发展中，但并不完整。公认的因素包括与患者，病理和围手术期护理有关的因素。诸如使用引流管，支架和各种药物来介导风险等干预措施仍在争论中。新兴数据表明，术后阶段的微生物组和炎症可能在POPF风险中起重要作用。可用的风险评分可对风险进行分层，并制定降低风险的缓解策略。但是，准确估计风险仍然是一个挑战，而且机制仅得到部分了解。结论POPF的病理生理学仍知之甚少。当前的模型仅部分解释了风险或相关机制。需要探索新的调查领域，以便进行更好的预测。准确估计风险仍然是一个挑战，并且仅能部分理解其机制。结论POPF的病理生理学仍知之甚少。当前的模型仅部分解释了风险或相关机制。需要探索新的调查领域，以便进行更好的预测。准确估计风险仍然是一个挑战，而且对机制的了解还很少。结论POPF的病理生理学仍知之甚少。当前的模型仅部分解释了风险或相关机制。需要探索新的调查领域，以便进行更好的预测。