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Risk Factors for Postoperative Pancreatic Fistulization Subsequent to Enucleation

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Pancreatectomies increase the risk of postoperative pancreatic fistula (POPF) and pancreatic insufficiency. Pancreatic enucleation preserves pancreatic parenchyma, lowers the risk of pancreatic insufficiency, but may induce specific complications (tumor recurrence or pancreatic fistulization). The aim of this study was to determine the risk factors for POPF following a pancreatic enucleation.

Methods

A retrospective analysis was designed based on data from patients who underwent pancreatic enucleation in five university hospitals (1998–2008). The presence of a pancreatic fistula was determined according to the criteria of the International Study Group of Pancreatic Fistula (Bassi et al. Surgery 138:8–13, 2005).

Results

Fifty-two patients (mean age 52 years) were included. Histological analysis revealed 35 endocrine tumors (68.6 %), 6 mucinous and 2 serous cyst adenomas, 2 metastases of renal cancer, and 8 benign tumors. Nineteen patients (36.5 %) suffered postoperative complications including 14 POPF (27 %). Median postoperative hospital stay was 12.9 days; 9.1 days without POPF versus 29 days with POPF (p < 0.05). Size of the tumor, its location, histological differentiation, and use of somatostatin analogs were not predictors for POPF. We defined the cutoff for POPF at a distance of 2 mm from the main pancreatic duct based on 60 % risk (≤2 mm) versus 19 % (>2 mm) of POPF (p < 0.01). With a mean follow-up of 30.8 months, one patient experienced recurrence of the tumor. No patients exhibited a new onset of diabetes or pancreatic insufficiency.

Conclusion

Enucleation for resection of pancreatic tumors located at less than or equal to two 2 mm from the main pancreatic duct is a risk factor for POPF. Enucleation is a safe and effective treatment for benign or borderline pancreatic tumors.

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Conflict of Interest

The authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Digestive and endocrine surgery, Clinique de Chirurgie Digestive et Endocrinienne, IMAD, University Hospital, Place Ricordeau, 44093 NANTES, France

    Céline Brient, Nicolas Regenet, Jenifer Milin & Eric Mirallié

  2. Department of Digestive Surgery, University Hospital, Rennes, France

    Laurent Sulpice & Bernard Meunier

  3. Department of Digestive Surgery, University Hospital, Nancy, France

    Laurent Brunaud, Ahmet Ayav & Laurent Bresler

  4. Department of Digestive Surgery, University Hospital, Angers, France

    Stéphanie Mucci-Hennekine & Antoine Hamy

  5. Department of Digestive Surgery, University Hospital, Toulouse, France

    Nicolas Carrère & Bernard Pradere

Authors
  1. Céline Brient
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  2. Nicolas Regenet
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  3. Laurent Sulpice
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  4. Laurent Brunaud
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  5. Stéphanie Mucci-Hennekine
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  6. Nicolas Carrère
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  7. Jenifer Milin
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  8. Ahmet Ayav
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  9. Bernard Pradere
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  10. Antoine Hamy
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  11. Laurent Bresler
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  12. Bernard Meunier
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  13. Eric Mirallié
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Corresponding author

Correspondence to Eric Mirallié.

Additional information

The institution from which the work originated is Clinique de Chirurgie Digestive et Endocrinienne, IMAD, University Hospital, Nantes, France.

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Brient, C., Regenet, N., Sulpice, L. et al. Risk Factors for Postoperative Pancreatic Fistulization Subsequent to Enucleation. J Gastrointest Surg 16, 1883–1887 (2012). https://doi.org/10.1007/s11605-012-1971-x

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  • DOI: https://doi.org/10.1007/s11605-012-1971-x

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