Abstract
Background
Laparoscopic distal pancreatectomy (LDP) is a treatment option for benign and borderline pancreatic tumors. However, pancreatic fistula (PF) remains a significant morbidity, contributing to the length of hospital stay and overall costs. In a consecutive series of 143 patients at a single institution, the predictive factors associated with PF after LDP were identified.
Methods
A retrospective study of patients who had undergone LDP between January 2003 and December 2013 was conducted. Patient demographic data and clinicopathological parameters were analyzed to evaluate their correlation with the incidence of PF.
Results
Among the 143 patients, the indications for surgery were benign disease in 117 (82 %) and malignant tumors in 26 (18 %). PF occurred in 25 (17 %) patients, 10 (40 %) of whom had clinically significant (grade B) PF. No grade C PF was observed. Multivariable analysis showed that pancreatic thickness was a significant predictive factor for PF (P < 0.001). A 12-mm cutoff value was based on the median pancreatic thickness in this series. Pancreatic texture alone was not a significant risk factor (P = 0.30); however, it became significant in patients with pancreatic thickness exceeding 12 mm (P = 0.005).
Conclusions
Pancreatic thickness exceeding 12 mm significantly increases the likelihood of PF after LDP. Pancreatic texture alone is not an independent risk factor for PF, but when combined with a thick parenchyma (>12 mm), a soft pancreas is predictive of PF.
Similar content being viewed by others
References
Pannegeon V, Pessaux P, Sauvanet A et al (2006) Pancreatic fistula after distal pancreatectomy. Arch Surg 141:1071–1076
Ridolfini MP, Alfieri S, Gourgiotis S et al (2007) Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial? World J Gastroenterol 13(38):5096–5100
Seeliger H, Christians S, Angele MK et al (2010) Risk factors for surgical complications in distal pancreatectomy. Am J Surg 200:311–317
Kneuertz PJ, Patel SH, Chu CK et al (2012) Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. J Am Coll Surg 215:167–176
Okano K, Kakinoki K, Yachida S et al (2008) A simple and safe pancreas transection using a stapling device for a distal pancreatectomy. J Hepatobiliary Pancreat Surg 15:353–358
Eguchi H, Nagano H, Tanemura M et al (2011) A thick pancreas is a risk factor for pancreatic fistula after distal pancreatectomy: selection of the closure technique according to thickness. Dig Surg 28:50–56
Zhou WZ, Lv R, Wang X et al (2010) Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg 200:529–536
Han HS, Min SK, Lee HK et al (2005) Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 19:1367–1369
Okano K, Oshima M, Kakinoki K et al (2013) Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler. Surg Today 43:141–147
Sledzianowski JF, Duffas JP, Muscari F et al (2005) Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery 137:180–185
Nathan H, Cameron JL, Goodwin CR et al (2009) Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg 250(2):277–281
Goh BK, Tan YM, Chung AYF et al (2008) Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome and management of postoperative pancreatic fistula. Arch Surg 143(10):956–965
Olah A, Issekutz A, Belagyi T et al (2009) Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy. Br J Surg 96:602–607
Ferrone CR, Warshaw AL, Rattner DW et al (2008) Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 12:1691–1698
Kleeff J, Diener MK, Z’graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 203 consecutive cases. Ann Surg 245:573–582
Fahy BN, Frey CF, Ho HS et al (2002) Morbidity, mortality and technical factors of distal pancreatectomy. Am J Surg 183:237–241
Kooby DA, Gillespie T, Bentrem D et al (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446
Soh YF, Kow AW, Wong KY et al (2012) Perioperative outcomes of laparoscopic and open distal pancreatectomy: our institution’s 5-year experience. Asian J Surg 35:29–36
Bassi C, Derveniz C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Yoshioka R, Saiura A, Koga R et al (2010) Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 34:121–125
Ban D, Shimada K, Konishi M et al (2012) Stapler and non-stapler closure of the pancreatic remnant after distal pancreatectomy: multicenter retrospective analysis of 388 patients. World J Surg 36:1866–1873
McMillan MT, Vollmer CM (2014) Predictive factors for pancreatic fistula following pancreatectomy. Langenbecks Arch Surg 399(7):811–824
Knaebel HP, Diener MK, Wente MN et al (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546
Diener MK, Knaebel HP, Witte ST et al (2008) DISPACT trial: a randomized controlled trial to compare two different surgical techniques of distal pancreatectomy. Clin Trials 5:534–545
Kawai M, Tani M, Okada K et al (2013) Stump closure of a thick pancreas using a stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg 206:352–359
Kajiyama T, Tsurumaru M, Udagawa H et al (1996) Quick and simple distal pancreatectomy using the GIA stapler: a report of 35 cases. Br J Surg 83:1711
Soejima Y, Shirabe K, Yoshizumi T et al (2013) A simple and secure ligation of the main pancreatic duct in distal pancreatectomy. J Am Coll Surg 216:23–25
Disclosures
Dr. Mendoza, Han, Ahn, Yoon, Cho and Choi have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mendoza, A.S., Han, HS., Ahn, S. et al. Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience. Surg Endosc 30, 649–656 (2016). https://doi.org/10.1007/s00464-015-4255-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4255-1