Langenbeck's Archives of Surgery

, Volume 403, Issue 3, pp 349–357 | Cite as

Computer tomographic assessment of postoperative peripancreatic collections after distal pancreatectomy

  • Yuichiro Uchida
  • Toshihiko Masui
  • Asahi Sato
  • Kazuyuki Nagai
  • Takayuki Anazawa
  • Kyoichi Takaori
  • Shinji Uemoto



Peripancreatic collections occur frequently after distal pancreatectomy. However, the sequelae of peripancreatic collections vary from case to case, and their clinical impact is uncertain. In this study, the correlations between CT findings of peripancreatic collections and complications after distal pancreatectomy were investigated.


Ninety-six consecutive patients who had undergone distal pancreatectomy between 2010 and 2015 were retrospectively investigated. The extent and heterogeneity of peripancreatic collections and background clinicopathological characteristics were analyzed. The extent of peripancreatic collections was calculated based on three-dimensional computed tomography images, and the degree of heterogeneity of peripancreatic collections was assessed based on the standard deviation of their density on computed tomography.


Of 85 patients who underwent postoperative computed tomography imaging, a peripancreatic collection was detected in 77 (91%). Patients with either a large extent or a high degree of heterogeneity of peripancreatic collection had a significantly higher rate of clinically relevant pancreatic fistula than those without (odds ratio 5.95, 95% confidence interval 2.12–19.72, p = 0.001; odds ratio 8.0, 95% confidence interval 2.87–24.19, p = 0.0001, respectively).


A large and heterogeneous peripancreatic collection was significantly associated with postoperative complications, especially clinically relevant postoperative pancreatic fistula. A small and homogenous peripancreatic collection could be safely observed.


Peripancreatic collection Distal pancreatectomy Pancreatic fistula 


Author’s contributions

Study conception and design: Yuichiro Uchida, Toshihiko Masui, Shinji Uemoto. Acquisition of data: Yuichiro Uchida, Asahi Sato, Kazuyuki Nagai, Takayuki Anazawa. Analysis and interpretation of data: Yuichiro Uchida. Drafting of the manuscript: Yuichiro Uchida and Toshihiko Masui. Critical revision of the manuscript: Kyoichi Takaori.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Hassenpflug M, Hinz U, Strobel O, Volpert J, Knebel P, Diener MK, Doerr-Harim C, Werner J, Hackert T, Büchler MW (2016) Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial). Ann Surg 264:723–730CrossRefPubMedGoogle Scholar
  2. 2.
    Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakamura M (2017) Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy. Surg Today 47(4):416–424CrossRefPubMedGoogle Scholar
  3. 3.
    Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, Falconi M, Pederzoli P (2007) Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula. Ann Surg 246:281–287CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Giglio M, Spalding D, Giakoustidis A et al (2016) Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection. BJS 103:328–336CrossRefGoogle Scholar
  5. 5.
    Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Yamaue H (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection. Ann Surg 244:1–7CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Van Buren G, Bloomston M, Schmidt C et al (2017) A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg 266(3):421–431CrossRefPubMedGoogle Scholar
  7. 7.
    Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRefPubMedGoogle Scholar
  9. 9.
    Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRefPubMedGoogle Scholar
  10. 10.
    Chang Y, Kang M, Kim H et al (2016) The natural course of pancreatic fistula and fluid collection after distal pancreatectomy. Ann Surg Treat Res 91:247–253CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Tjaden C, Hinz U, Hassenpflug M, Fritz F, Fritz S, Grenacher L, Büchler MW, Hackert T (2016) Fluid collection after distal pancreatectomy: a frequent finding. HPB 18:35–40CrossRefPubMedGoogle Scholar
  12. 12.
    Kawai M, Tani M, Okada K, Hirono S, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H (2013) Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg 206:352–359CrossRefPubMedGoogle Scholar
  13. 13.
    Banks P, Bollen T, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111CrossRefPubMedGoogle Scholar
  14. 14.
    Cheng Y, Xia J, Lai M et al (2016) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 21:10Google Scholar
  15. 15.
    Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252(2):207–214CrossRefPubMedGoogle Scholar
  16. 16.
    Nagakawa Y, Matsudo T, Hijikata Y, Kikuchi S, Bunso K, Suzuki Y, Kasuya K, Tsuchida A (2013) Bacterial contamination in ascitic fluid is associated with the development of clinically relevant pancreatic fistula after pancreatoduodenectomy. Pancreas 42(4):701–706CrossRefPubMedGoogle Scholar
  17. 17.
    Yamashita K, Sasaki T, Itoh R, Kato D, Hatano N, Soejima T, Ishii K, Takenawa T, Hiromatsu K, Yamashita Y (2015) Pancreatic fistulae secondary to trypsinogen activation by Pseudomonas aeruginosa infection after pancreatoduodenectomy. J Hepatobiliary Pancreat Sci 22(6):454–462CrossRefPubMedGoogle Scholar
  18. 18.
    Ohgi K, Sugiura T, Yamamoto Y, Okamura Y, Ito T, Uesaka K (2016) Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy. Surgery 160(3):725–730CrossRefPubMedGoogle Scholar
  19. 19.
    Robert B, Yzet T, Regimbeau JM (2013) Radiologic drainage of post-operative collections and abscesses. J Visc Surg 150(3 Suppl):S11–S18CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yuichiro Uchida
    • 1
  • Toshihiko Masui
    • 1
  • Asahi Sato
    • 1
  • Kazuyuki Nagai
    • 1
  • Takayuki Anazawa
    • 1
  • Kyoichi Takaori
    • 1
  • Shinji Uemoto
    • 1
  1. 1.Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of SurgeryKyoto UniversityKyotoJapan

Personalised recommendations