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The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy

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Abstract

Objectives

Pancreatic fistula after distal pancreatectomy (DP) remains an unsolved problem, and postoperative CT imaging often demonstrates fluid collection (FC) around the pancreatic remnant. This study sought to clarify the clinical implications of FC.

Methods

This study enrolled 146 patients who underwent DP. FC was defined as a cyst-like lesion ≥ 10 mm in diameter on CT imaging at postoperative day (POD) 7. FC size, irregularity of FC margin, and air bubbles in FC were investigated. In addition, clinical data were retrospectively collected, and useful predictive factors for postoperative pancreatic fistula (POPF) were analyzed.

Results

Clinically relevant POPF was observed in 26 patients (17.8%), and FC was detected in 136 patients (94.4%). Multivariate analysis identified FC size and drain amylase levels on POD3 as significant risk factors for POPF. Cutoff values were determined by ROC analyses, and the levels of the FC size and drain amylase on POD3 were determined as 41 mm and 1026 IU/L, respectively. The sensitivity and specificity of FC diameters > 41 mm were 76.9% and 75.0%, respectively, while those of drain amylase levels > 1026 IU on POD3 were 73.1% and 75.8%, respectively.

Conclusions

While treating some FCs after DP was necessary for the management of POPF, others did not require any intervention since most of them spontaneously disappeared. FC size and drain amylase levels on POD3 were found to be significantly associated with POPF and could potentially help to determine appropriate treatment.

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Acknowledgements

This study was supported by a grant from the Japan Society for the Promotion of Science (JSPS KAKENHI #17K10689).

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Jun Yoshino, Daisuke Ban, Toshiro Ogura, Kosuke Ogawa, Hiroaki Ono, Yusuke Mitsunori, Atsushi Kudo & Minoru Tanabe

  2. Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Shinji Tanaka

Authors
  1. Jun Yoshino
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  2. Daisuke Ban
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  3. Toshiro Ogura
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  4. Kosuke Ogawa
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  5. Hiroaki Ono
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  6. Yusuke Mitsunori
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  7. Atsushi Kudo
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  8. Shinji Tanaka
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  9. Minoru Tanabe
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Contributions

Author contributions to the study and manuscript preparation include the following: Jun Yoshino, Daisuke Ban, and Minoru Tanabe conceived the design. Jun Yoshino, Toshiro Ogura, Kosuke Ogawa, and Hiroaki Ono collected and assembled the clinical data. Jun Yoshino and Daisuke Ban reviewed CT imaging. Jun Yoshino, Daisuke Ban, Atsushi Kudo, and Shinji Tanaka analyzed and interpreted the data. Jun Yoshino, Daisuke Ban, and Yusuke Mitsunori wrote the manuscript. Jun Yoshino, Daisuke Ban, Toshiro Ogura, Kosuke Ogawa, Hiroaki Ono, Yusuke Mitsunori, Atsushi Kudo, Shinji Tanaka, and Minoru Tanabe finally approved the manuscript.

Corresponding author

Correspondence to Daisuke Ban.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Yoshino, J., Ban, D., Ogura, T. et al. The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy. World J Surg 43, 2069–2076 (2019). https://doi.org/10.1007/s00268-019-05009-8

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  • DOI: https://doi.org/10.1007/s00268-019-05009-8

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