Management of Clinically Relevant Postoperative Pancreatic Fistula-related Fluid Collections After Distal Pancreatectomy

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2022 Nov 10

PMID 36357548

Authors

Giovanni Guarneri

Giorgia Guazzarotti

Nicolo Pecorelli

Diego Palumbo

Marco Palucci

Lorenzo Provinciali

Chiara Limongi

Stefano Crippa

Stefano Partelli

Francesco De Cobelli

Massimo Falconi

Affiliations

Soon will be listed here.

Abstract

Background: Distal pancreatectomy is burdened by a high rate of clinically relevant postoperative pancreatic fistula (CR-POPF). The presence of a fistula-related abdominal collection often requires additional treatment such as antibiotics, percutaneous drainage, and endoscopic drainage thus prolonging patient recovery. Aim of this study was to describe the management of abdominal collections related to CR-POPF and identify variables associated with the need for invasive procedures.

Methods: A retrospective review of clinical data for patients who underwent distal pancreatectomy between 2015 and 2020 was conducted. All postoperative CT-scan imaging performed for clinical signs related to POPF was reviewed. The main outcome of the study was the need for procedural management (percutaneous or endoscopic) of CR-POPF-related fluid collections at 90 days after surgery. A multivariate regression analysis was adopted to analyze factors influencing procedural management of the collection.

Results: Five hundred sixteen patients were included in the study. Laparoscopic resection was performed in 290 patients (56%). At 90 days after surgery, CR-POPF occurred in 207 (40.1%) patients. A symptomatic collection related to fistula was observed in 130 patients (25.2%). Factors associated with fluid collections were increased body mass index (BMI) (25.5 versus 24, p = 0.001) and intraoperative blood loss (median of 250 versus 200 ml, p < 0.001). Procedural management was required in 70 patients (13.6%); 52 patients required interventional radiology and 18 endoscopic drainage. At multivariate analysis, risk factors for invasive procedures were the following CT-scan parameters: fluid collection diameter greater than 5 cm (OR 6.366, 95%CI 2.29-17.66, p = 0.001), presence of blood in the fluid collection (OR 10.618, 95%CI 1.94-58.09, p = 0.006), and enhancement of its walls (OR 4.073, 95%CI 1.22-13.57, p = 0.022).

Conclusion: CR-POPF-related fluid collections affect about a quarter of patients undergoing distal pancreatectomy. CT-scan provides important information which can guide the management of the collection in a "step-up" fashion.

Citing Articles

Topical application of Glauber's salt accelerates the absorption of abdominal fluid after pancreatectomy.

Li J, Hua J, Ruan H, Xu H, Liang C, Meng Q BMC Surg. 2024; 24(1):398.

PMID: 39709411 PMC: 11662731. DOI: 10.1186/s12893-024-02696-6.

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