Perioperative hydrocortisone treatment reduces postoperative pancreatic fistula rate after open distal pancreatectomy. A randomized placebo-controlled trial

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intra-operative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.

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Simplicity and Safety: Minimized Pancreatic Fistula Rate after Distal Pancreatectomy through Pancreas Stump Sutured Fish-Mouth Closure

The American Surgeon ◽

10.1177/000313481808401127 ◽

2018 ◽

Vol 84 (11) ◽

pp. 1734-1740

Author(s):

Michael J. Minarich ◽

Roderich E. Schwarz

Keyword(s):

Length Of Stay ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Surgical Oncology ◽

Postoperative Recovery ◽

Splenic Vessel ◽

Pancreatic Stump ◽

Fistula Rate ◽

Oncology Practice ◽

Pancreatic Fistula Rate

Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. Seventy-five of 294 pancreatectomy patients underwent DP (26%). There were 33 men and 42 women, with a median age of 61 years (range: 18–85 years). Underlying conditions included cancer (60%) and benign processes (40%). Resections were comprising open DP (64%), laparoscopic DP (21%), and open multivisceral resections (15%). Of 21 cases with postoperative complications (28%, no death), six were PFs (8%, 2 grade A and 4 grade B). The median length of stay was six days (4–24). The PF rate was 2.0 per cent in 50 patients after sutured fish-mouth closures, but 20 per cent in cases using other techniques including stapling ( P = 0.007); no other variable was linked to PF occurrence. Length of stay was linked to complications, resection extent, malignancy, and transfusions (all at P < 0.02), but not to PF. PF rate after DP in this experience is unaffected by splenic vessel resection but seems to be minimized through a sutured fish-mouth closure technique.

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Reduced Postoperative Pancreatic Fistula Rate After Pancreatogastrostomy Versus Pancreaticojejunostomy

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-008-0763-9 ◽

2008 ◽

Vol 13 (4) ◽

pp. 745-751 ◽

Cited By ~ 45

Author(s):

U. Wellner ◽

F. Makowiec ◽

E. Fischer ◽

U. T. Hopt ◽

T. Keck

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Fistula Rate ◽

Pancreatic Fistula Rate

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Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy

Surgery ◽

10.1016/j.surg.2021.11.009 ◽

2021 ◽

Author(s):

Nicky van der Heijde ◽

Sanne Lof ◽

Olivier R. Busch ◽

Ignace de Hingh ◽

Ruben H. de Kleine ◽

...

Keyword(s):

Minimally Invasive ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

Open Distal Pancreatectomy

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A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08724-3 ◽

2021 ◽

Author(s):

Luca Landoni ◽

Matteo De Pastena ◽

Martina Fontana ◽

Giuseppe Malleo ◽

Alessandro Esposito ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Controlled Trial ◽

Intraoperative Ultrasound ◽

Postoperative Pancreatic Fistula ◽

Ultrasonic Dissection ◽

Randomized Controlled ◽

Significant Difference ◽

Secondary Endpoints

Abstract Background The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy. Methods Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection and a parenchymal thickness > 17 mm on intraoperative ultrasound. Eligible patients were randomized in a 1:1 ratio to stapled transection (Endo GIA Reinforced Reload with Tri-Staple Technology®) or ultrasonic transection (Harmonic Focus® + or Harmonic Ace® + shears). The primary endpoint was postoperative pancreatic fistula. Secondary endpoints included overall complications, abdominal collections, and length of hospital stay. Results Overall, 72 patients were randomized in the stapled transection arm and 73 patients in the ultrasonic transection arm. Postoperative pancreatic fistula occurred in 23 patients (16%), with a comparable incidence between groups (12% in stapled transection versus 19% in ultrasonic dissection arm, p = 0.191). Overall complications did not differ substantially (35% in stapled transection versus 44% in ultrasonic transection arm, p = 0.170). There was an increased incidence of abdominal collections in the ultrasonic dissection group (32% versus 14%, p = 0.009), yet the need for percutaneous drain did not differ between randomization arms (p = 0.169). The median length of stay was 8 days in both groups (p = 0.880). Intraoperative blood transfusion was the only factor independently associated with postoperative pancreatic fistula on logistic regression analysis (OR 4.8, 95% CI 1.2–20.0, p = 0.032). Conclusion The present randomized controlled trial of stapled versus ultrasonic transection in elective distal pancreatectomy demonstrated no significant difference in postoperative pancreatic fistula rates and no substantial clinical impact on other secondary endpoints.

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