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Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background

Postoperative pancreatic fistula (POPF) is a major, intractable complication after distal pancreatectomy (DP). Risk factor evaluation and prevention of this complication are important tasks for pancreatic surgeons.

Methods

One hundred and six patients who underwent DP using a stapler for pancreatic division were retrospectively investigated. The relationship between clinicopathological factors and the incidence of POPF was statistically analyzed.

Results

Clinically relevant, Grade B or C POPF by International Study Group of Pancreatic Fistula criteria occurred in 52 patients (49.1 %). Age, American Society of Anesthesiologists score, body mass index, and concomitant gastrointestinal tract resection did not influence the incidence of POPF. Use of a double-row stapler and a thick pancreatic stump were significant risk factors for POPF in multivariate analysis. Compression index was also shown to be an important factor in cases in which the pancreas was divided by a stapler.

Conclusions

The most important risk factor for POPF after DP was suggested to be the thickness of the pancreatic stump, reflecting the volume of remnant pancreas. A triple-row stapler seemed to be superior to a double-row stapler in preventing POPF. However, triple-row stapler use in a thick pancreas is considered to be a future problem to be solved.

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Author notes

  1. Naoto Gotohda

    Present address: National Cancer Center East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan

Authors and Affiliations

  1. Department of Digestive Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan

    Motokazu Sugimoto, Naoto Gotohda, Yuichiro Kato, Shinichiro Takahashi, Takahiro Kinoshita, Hidehito Shibasaki & Masaru Konishi

  2. Clinical Trial Section, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan

    Shogo Nomura

  3. Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan

    Motokazu Sugimoto & Hironori Kaneko

Authors
  1. Motokazu Sugimoto
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  2. Naoto Gotohda
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  3. Yuichiro Kato
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  4. Shinichiro Takahashi
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  5. Takahiro Kinoshita
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  7. Shogo Nomura
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  8. Masaru Konishi
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Corresponding authors

Correspondence to Motokazu Sugimoto or Naoto Gotohda.

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Sugimoto, M., Gotohda, N., Kato, Y. et al. Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use. J Hepatobiliary Pancreat Sci 20, 538–544 (2013). https://doi.org/10.1007/s00534-013-0596-0

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  • DOI: https://doi.org/10.1007/s00534-013-0596-0

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