Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience

Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

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Does low level of drain amylase warrant the absence of postoperative pancreatic fistula after laparoscopic distal pancreatectomy?

HPB ◽

10.1016/j.hpb.2018.06.2199 ◽

2018 ◽

Vol 20 ◽

pp. S625-S626

Author(s):

I.G. Hyun ◽

Y.-S. Yoon ◽

H.-S. Han ◽

J.Y. Cho ◽

Y. Choi ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Laparoscopic Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

Low Level ◽

Drain Amylase

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Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution

ANZ Journal of Surgery ◽

10.1111/ans.13661 ◽

2016 ◽

Vol 87 (12) ◽

pp. E271-E275 ◽

Cited By ~ 18

Author(s):

Brian K. P. Goh ◽

Chung Yip Chan ◽

Ser Yee Lee ◽

Weng Hoong Chan ◽

Peng Chung Cheow ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Laparoscopic Distal Pancreatectomy ◽

Initial Experience ◽

Single Institution ◽

Open Conversion ◽

Factors Associated

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Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon

PLoS ONE ◽

10.1371/journal.pone.0172857 ◽

2017 ◽

Vol 12 (2) ◽

pp. e0172857 ◽

Cited By ~ 9

Author(s):

Tao Xia ◽

Jia-Yu Zhou ◽

Yi-Ping Mou ◽

Xiao-Wu Xu ◽

Ren-Chao Zhang ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Laparoscopic Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

Closure Technique

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Significance of Preoperative Pancreatic MRI Findings in Predicting Factors for Postoperative Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Cancer: A Retrospective Study

10.21203/rs.3.rs-641857/v1 ◽

2021 ◽

Author(s):

Masahiro Fukada ◽

Katsutoshi Murase ◽

Toshiya Higashi ◽

Ryoma Yokoi ◽

Hideharu Tanaka ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Predictive Factors ◽

Univariate Analysis ◽

Postoperative Pancreatic Fistula ◽

University Hospital ◽

Imaging Biomarkers ◽

Mri Findings ◽

Related Factors

Abstract Background: Postoperative pancreatic fistula (POPF) is the most serious complication of distal pancreatectomy (DP). For patients with pancreatic cancer (PC), POPF can have a negative effect on both short- and long-term prognoses. This study aimed to identify clinical outcomes of POPF after DP for PC and predictive factors for POPF.Methods: This retrospective, single-institution study comprised 48 patients with PC who underwent open DP (excluding simultaneous resection of other organs and other pancreatic diseases) between January 2010 and December 2020 at the Gifu University Hospital. We statistically analyzed patient-, pancreas-, cancer-, and surgery-related factors for predicting outcomes and risk factors for POPF. Results: According to the International Study Group of Pancreatic Fistula (ISGPF) definition and grading, 11 (22.9%) of 48 patients had POPF grades B and C. Among 22 related factors, POPF was significantly associated with pancreatic width (p = 0.04) and the pancreas-to-muscle signal intensity ratio (SIR) on T1-weighted magnetic resonance imaging (MRI, p = 0.02) in univariate analysis. In multivariate analysis, both pancreatic width (≥23 mm, odds ratio [OR] 9.37; 95% confidence interval [CI] 1.22–202.40; p = 0.03) and SIR on T1-weighted MRI (≥1.37, OR 17.10; 95% CI 2.38–359.04; p = 0.003) were identified as independent predictive factors for POPF. Conclusion: Pancreatic width and pancreas-to-muscle SIR on T1-weighted MRI significantly correlated with POPF after DP for PC. These parameters may be potential imaging biomarkers for predicting POPF in pancreatic surgery.

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