Dr Brian Goh and colleagues from Singapore critically analyzed a large single-institution experience with distal pancreatectomy with particular attention to the risk factors, outcome, and management of the postoperative pancreatic fistula.
The team assessed a total of 232 consecutive patients with pancreatic or extrapancreatic disease necessitating distal pancreatectomy over 21 years.
The research team reported that 21 patients underwent spleen-preserving distal pancreatectomy, and 117 underwent distal pancreatectomy with appendectomy.
|Overall operative mortality was 3%|
|Archives of Surgery |
A further 94 patients underwent distal pancreatectomy with multiorgan resection.
The researchers analyzed the perioperative and postoperative data of patients who underwent distal pancreatectomy.
The team assessed factors associated with postoperative morbidity with particular attention to the pancreatic fistula and changing trends in operative and perioperative data during the study period.
The researchers found that the overall operative morbidity and mortality were 47%, and 3%, respectively.
During the study period, the rates of resection increased from 3 cases to 23 per year, and increasingly these were performed for smaller and incidental lesions.
The morbidity rate remained unchanged, but there was a decline in postoperative stay and the need for care in the intensive care unit.
The team found that pancreatic fistulas occurred in 31%, of which 18% were Grade A, 6% were Grade B, and 8% were Grade C.
Increased weight, higher American Society of Anesthesiologists score, blood loss greater than 1 L, and increased operation time were associated with a postoperative pancreatic fistula.
Decreased albumin level, and sutured closure of the stump without main duct ligation were associated with a postoperative pancreatic fistula on univariate analysis.
A distal pancreatectomy with splenectomy was associated with a higher incidence of Grade B or C pancreatic fistula and non–pancreatic fistula -related complications.
The research team observed that 92% of pancreatic fistula’s were successfully managed nonoperatively.
Clinical outcomes correlated well with pancreatic fistula grading.
This correlation was evidenced by the progressive increase in outcome measures such as postoperative stay, readmissions, reoperations, radiologic interventions, and non–pancreatic fistula-related complications from Grade A to C pancreatic fistula’s.
Dr Goh‘s team concluded, “Pancreatic fistula is the most common complication after distal pancreatectomy and its incidence varies depending on the definition applied.”
“Several risk factors for developing a pancreatic fistula were identified.”
“Splenic preservation after distal pancreatectomy is safe.”
“The grade of a pancreatic fistula correlates well with clinical outcomes, and most pancreatic fistula’s may be managed nonoperatively.”