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Management of clinically relevant postoperative pancreatic fistula-related fluid collections after distal pancreatectomy

  • 2022 SAGES Oral
  • Published:
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Abstract

Background

Distal pancreatectomy is burdened by a high rate of clinically relevant postoperative pancreatic fistula (CR-POPF). The presence of a fistula-related abdominal collection often requires additional treatment such as antibiotics, percutaneous drainage, and endoscopic drainage thus prolonging patient recovery. Aim of this study was to describe the management of abdominal collections related to CR-POPF and identify variables associated with the need for invasive procedures.

Methods

A retrospective review of clinical data for patients who underwent distal pancreatectomy between 2015 and 2020 was conducted. All postoperative CT-scan imaging performed for clinical signs related to POPF was reviewed. The main outcome of the study was the need for procedural management (percutaneous or endoscopic) of CR-POPF-related fluid collections at 90 days after surgery. A multivariate regression analysis was adopted to analyze factors influencing procedural management of the collection.

Results

Five hundred sixteen patients were included in the study. Laparoscopic resection was performed in 290 patients (56%). At 90 days after surgery, CR-POPF occurred in 207 (40.1%) patients. A symptomatic collection related to fistula was observed in 130 patients (25.2%). Factors associated with fluid collections were increased body mass index (BMI) (25.5 versus 24, p = 0.001) and intraoperative blood loss (median of 250 versus 200 ml, p < 0.001). Procedural management was required in 70 patients (13.6%); 52 patients required interventional radiology and 18 endoscopic drainage. At multivariate analysis, risk factors for invasive procedures were the following CT-scan parameters: fluid collection diameter greater than 5 cm (OR 6.366, 95%CI 2.29–17.66, p = 0.001), presence of blood in the fluid collection (OR 10.618, 95%CI 1.94–58.09, p = 0.006), and enhancement of its walls (OR 4.073, 95%CI 1.22–13.57, p = 0.022).

Conclusion

CR-POPF-related fluid collections affect about a quarter of patients undergoing distal pancreatectomy. CT-scan provides important information which can guide the management of the collection in a “step-up” fashion.

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Acknowledgements

Giovanni Guarneri research fellowship is funded by the Umberto Veronesi Foundation.

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  1. Giovanni Guarneri and Giorgia Guazzarotti share the first authorship.

Authors and Affiliations

  1. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Giovanni Guarneri, Nicolò Pecorelli, Stefano Crippa, Stefano Partelli & Massimo Falconi

  2. Division of Radiology, San Raffaele Scientific Institute, Milan, Italy

    Giorgia Guazzarotti, Diego Palumbo & Francesco De Cobelli

  3. Vita-Salute San Raffaele University, Milan, Italy

    Nicolò Pecorelli, Diego Palumbo, Marco Palucci, Lorenzo Provinciali, Chiara Limongi, Stefano Crippa, Stefano Partelli, Francesco De Cobelli & Massimo Falconi

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  1. Giovanni Guarneri
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Correspondence to Nicolò Pecorelli.

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Giovanni Guarneri, Diego Palumbo, Nicolò Pecorelli, Giorgia Guazzarotti, Marco Palucci, Lorenzo Provinciali, Chiara Limongi, Stefano Crippa, Stefano Partelli, Francesco De Cobelli, and Massimo Falconi have no conflicts of interests or financial ties to disclose.

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Accepted as Oral presentation at SAGES 2022 Annual Meeting in Denver (CO).

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Guarneri, G., Guazzarotti, G., Pecorelli, N. et al. Management of clinically relevant postoperative pancreatic fistula-related fluid collections after distal pancreatectomy. Surg Endosc 37, 5623–5634 (2023). https://doi.org/10.1007/s00464-022-09713-w

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