P-P44 Clinical outcomes of consecutive patients undergoing distal pancreatectomy over the last decade at a high volume tertiary pancreatic surgery unit

Abstract Background Distal pancreatectomy (DP) enables resection of lesions in the body and tail of the pancreas. Over the past decade, the Laparoscopic approach has become frequently employed. There remains scarce outcome data available following laparoscopic distal pancreatectomy over a long time period from high volume centres. Postoperative pancreatic fistula (POPF) remains the main source of morbidity and mortality after DP. The causes of POPF are multifactorial and poorly understood. The optimal method of pancreatic stump closure is still debated with variation in clinical practice. Methods All patients that underwent distal pancreatectomy at a UK tertiary pancreatic surgery centre between January 2011 and January 2021 were identified and clinical outcomes examined. Patients undergoing completion pancreatectomies were excluded. Clinical, pathological and surgical data for the included patients was retrospectively collected from the electronic patient record. Clinically significant POPF was defined as Grade B or C as per the ISGPF guidelines. For stapled stump closure, the Compression Index (CI) was calculated using closed staple height (mm) divided by the pancreatic thickness (mm). High and low CI was defined around the median. Results 233 patients (n = 90 open and n = 143 laparoscopic) were included in the final analysis. The laparoscopic approach was associated with comparable morbidity and significantly lower blood loss, shorter operative time and shorter length of stay. There were no significant differences in age, sex, final histology, closure technique, or ASA Score of 3 or more amongst patients with clinically relevant POPF (CR-POPF). The POPF group had a significantly higher BMI, drain duration and readmission rate. CI data was available for 78 cases (range 0.04-0.21). There was no significant difference in low vs high CI for patients with CR-POPF. Conclusions Laparoscopic distal pancreatectomy is associated with favourable clinical outcomes in this series. Stapled vs sutured closure of the pancreatic stump offered equivocal outcomes with relation to POPF. POPF continues to have a significant impact on a clinical recovery as evident from longer drain duration and high readmission rates. Further research is required to try to establish methods for reducing the incidence of POPF after distal pancreatectomy.

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Laparoscopic and Open Distal Pancreatectomy: A Comparison of Outcomes

The American Surgeon ◽

10.1177/000313480907500807 ◽

2009 ◽

Vol 75 (8) ◽

pp. 671-680 ◽

Cited By ~ 15

Author(s):

Kelly R. Finan ◽

Emily E. Cannon ◽

Eugenia J. Kim ◽

Mary M. Wesley ◽

Pablo J. Arnoletti ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Pancreatic Surgery ◽

Univariate Analysis ◽

High Volume ◽

Fistula Formation ◽

Perioperative Outcomes ◽

Surgical Approaches ◽

Open Distal Pancreatectomy ◽

Significant Difference

Laparoscopic (lap) pancreatic surgery has been increasingly reported since its introduction in 1992. A retrospective analysis of consecutive patients undergoing elective lap and open distal pancreatectomy from 2002 to 2007 was performed. Univariate analysis was completed to evaluate perioperative variables. Logistic regression analysis was used to model predictors of postoperative pancreatic fistula. One hundred forty-eight subjects underwent distal pancreatectomy; 98 completed open, 44 lap, and six converted to open. There was no significant difference in the incidence of postoperative morbidity or mortality between the surgical approaches. Decreased operative time (156 vs 200 minutes, P < 0.01), blood loss (157 vs 719 mL, P < 0.01), and length of stay (5.9 vs 8.6 days, P < 0.01) were seen in the lap group. There was no significant difference in the rate of all pancreatic fistula formation (50 vs 46%, P = 0.94) or clinically significant leaks (18 vs 19%, P = 0.97) between techniques. A preoperative biopsy-proven cancer, increasing body mass index, history of pancreatitis, and male gender were significant predictors of having a pancreatic fistula. Lap and open distal pancreatectomy are performed safely at high-volume pancreatic surgery centers. This report provides ongoing support of the feasibility and safety of the lap approach with improved perioperative outcomes and equivalent pancreatic fistula rate.

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The laparoscopic approach to distal pancreatectomy is a value-added proposition for patients undergoing care in moderate-volume and high-volume centers

Surgery ◽

10.1016/j.surg.2019.04.019 ◽

2019 ◽

Vol 166 (2) ◽

pp. 166-171

Author(s):

Emanuel Eguia ◽

Paul C. Kuo ◽

Patrick Sweigert ◽

Marc Nelson ◽

Gerard V. Aranha ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Laparoscopic Approach ◽

Value Added ◽

High Volume ◽

A Value ◽

Moderate Volume

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Surgical outcomes are hampered after endoscopic ultrasonography-guided ethanol lavage and/or Taxol injection in cystic lesions of the pancreas

10.21203/rs.3.rs-135426/v1 ◽

2021 ◽

Author(s):

Seong-Ryong Kim ◽

Kwang-Min Park ◽

Dae Wook Hwang ◽

Jae Hoon Lee ◽

Sang Hyun Shin ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Clinical Outcomes ◽

Endoscopic Ultrasonography ◽

Surgical Outcomes ◽

Pancreatic Head ◽

Laparoscopic Distal Pancreatectomy ◽

Ductal Adenocarcinoma ◽

Cystic Tumor ◽

Solid Pseudopapillary Tumor ◽

Cystic Lesions

Abstract Background and Aims Endoscopic ultrasonography-guided ethanol lavage and Taxol injection (EUS-ELTI) in pancreatic cystic lesions have been recently performed in some medical centers. This study aimed to optimize the patient selection and analyze the outcomes in patients who underwent surgery after EUS-ELTI in pancreatic cystic lesions. Methods Among 310 patients who underwent EUS-ELTI between January 2007 and December 2014, 23 underwent surgery after EUS-ELTI owing to incomplete treatment and/or adverse events. We evaluated the surgical outcomes in patients who underwent surgery after EUS-ELTI. Then, we retrospectively compared the clinical outcomes of the patients who underwent the surgery after EUS-ELTI with those of patients who underwent upfront surgery for left-sided pancreatic lesions without the EUS-ELTI procedure. Results The pathology revealed degenerated cysts in 12 patients, mucinous cyst neoplasms in five patients, neuroendocrine tumors in two patients, and one intraductal papillary mucinous neoplasm (IPMN), one solid pseudopapillary tumor, one pancreatic ductal adenocarcinoma arising from an IPMN, and one hepatoid carcinoma. Twelve patients underwent laparoscopic distal pancreatectomy and five patients underwent open distal pancreatectomy. All six patients who had lesions in the pancreatic head underwent open pancreaticoduodenectomy. When we retrospectively compared the clinical outcomes between patients who underwent laparoscopic distal pancreatectomy after EUS-ELTI and those who did not receive the EUS-ELTI procedure, the spleen-preserving rate was 0% in the EUS-ELTI group and 61.7% (365/592) in the non-EUS-ELTI group (P < 0.001). Clinically relevant postoperative pancreatic fistulas occurred in 33.3% of patients in the EUS-ELTI group and in 6.8% of patients in the non-EUS-ELTI group (P = 0.025). The mean postoperative hospital stay was also shorter in the non-EUS-ELTI group than in the EUS-ELTI group (8.66 ± 5.66 and 13.56 ± 7.20, P = 0.032). Conclusion Surgical outcomes are compromised after EUS-ELTI in the cystic tumor of the pancreas. Further investigations are needed for investigation of the efficacy and safety of the EUS-ELTI procedure.

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Outcomes after Distal Pancreatectomy for Trauma in the Modern Era

The American Surgeon ◽

10.1177/000313481608200614 ◽

2016 ◽

Vol 82 (6) ◽

pp. 526-532 ◽

Cited By ~ 1

Author(s):

Gregory L. Peck ◽

David N. Blitzer ◽

Constantine S. Bulauitan ◽

Lauren A. Huntress ◽

Paul Truche ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Early Death ◽

Outcome Data ◽

Trauma Patients ◽

Pancreatic Stump ◽

Fibrin Sealants ◽

Stump Closure ◽

Pancreatic Injuries ◽

Fistula Rate

Multiple stump closure techniques after distal pancreatectomy (DP) for trauma have been described, and all are associated with a significant fistula rate. With increasing emphasis on abbreviated laparotomy, stapled pancreatectomy has become more common. This study describes the outcomes of patients with different closure techniques of the pancreatic stump after resection following pancreatic trauma. Retrospective analysis of 50 trauma patients, who sustained grade III pancreatic injuries with subsequent DP and stapled stump closure, were conducted from 1995 to 2011. Demographic, operative, and outcome data were analyzed to characterize patients, and to directly compare closure techniques. After 12 patients were excluded because of early death (<72 hours), final analyses included 38 patients: 19 (50%) had stapled closure alone and 19 (50%) had stapling with adjunct, including additional closure with sutures, fibrin sealants, or a combination of sutures with fibrin sealants/omental coverage. Twenty-four patients (63%) had postoperative complications, most commonly pancreatic fistula (n = 11, 29%). There were no significant differences with regard to pancreatic fistula or other abdominal complications between closure groups, or were any factors associated with increased likelihood of complications. DP remains a morbid operation after trauma regardless of closure technique. Stapled closure alone is perhaps the method of choice in this setting due to the time constraints directly related to outcomes.

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Preventing clinically relevant pancreatic fistula with combination of linear stapling plus continuous suture of the stump in laparoscopic distal pancreatectomy

BMC Surgery ◽

10.1186/s12893-020-00876-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Takeshi Aoki ◽

Doaa A. Mansour ◽

Tomotake Koizumi ◽

Kazuhiro Matsuda ◽

Tomokazu Kusano ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Laparoscopic Distal Pancreatectomy ◽

Triple Combination ◽

Continuous Suture ◽

Remnant Pancreas ◽

Stump Closure ◽

Suture Group

Abstract Background Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate. Methods Twenty-two patients underwent LDP at our institution between 2011 and 2013. Twelve patients had linear stapling closure with peri-firing compression (LSC) alone compared with ten patients who had linear stapling closure, peri-firing compression plus continuous suture (LSC/CS) for stump closure of remnant pancreas in LDP. Biochemical leak and clinically relevant POPF were compared between both groups. Results POPF occurred in 4 of 12 (33.3%) patients with linear stapling closure while no patient developed a clinically relevant POPF in the triple combination of linear stapling, peri-firing compression plus continuous suture group (p = 0.043).1 patient (8.3%) in the LSC group and 5 patients (50%) in the LSC/CS group had evidence of a biochemical leak. There were no significant differences in operative time (188.3 vs 187.0 min) and blood loss (135 vs. 240 g) between both groups but there was a significantly of shorter length of hospital stay (11.9 vs. 19.9 days) in LSC/CS group (p = 0.037). There was no mortality in either group. Conclusions The triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF. Trial registration The study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.

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