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The location of perianastomotic fluid collection predicts postoperative complications after pancreaticoduodenectomy

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Abstract

Purpose

Perianastomotic fluid collection (PFC) is one of the postoperative complications of pancreaticoduodenectomy (PD). However, no studies have investigated the clinical significance of PFC location and volume during the early postoperative period. This study aimed to assess the association between PFC during the early postoperative period and postoperative complications.

Methods

Medical records of 148 patients who had undergone PD and computed tomography (CT) on postoperative day 4 were retrospectively reviewed. The location—superior, inferior, ventral, dorsal, or splenic hilum—and PFC index, which is the estimated volume of fluid collection, were determined using CT. The associations between postoperative complication and the presence of PFC, and PFC index according to the location, were assessed.

Results

The PFC group included 102 patients (69%). Postoperative pancreatic fistula (POPF) and organ/space surgical site infection (SSI) were more frequent in the PFC group (42% vs 9%, p < 0.001 and 29% vs 11%, p = 0.020, respectively). Additionally, the PFC index was larger in patients who developed POPF, organ/space SSI, or pseudoaneurysm (81 cm3 vs 19 cm3, p < 0.001; 75 cm3 vs 30 cm3, p = 0.001; and 185 cm3 vs 31 cm3, p < 0.001, respectively). Furthermore, superior and ventral PFCs were associated with pseudoaneurysm (11% vs 0%, p = 0.006 and 14% vs 1%, p = 0.002, respectively), whereas inferior and dorsal PFCs were associated with deep incisional SSI (9% vs 0%, p = 0.027 and 8% vs 1%, p = 0.034, respectively).

Conclusion

The PFC location during the early postoperative period is associated with postoperative complications. Our findings may help determine the optimal location of prophylactic drains.

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Author information

Authors and Affiliations

  1. Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan

    Hiromitsu Maehira, Hiroya Iida, Takashi Matsunaga, Daiki Yasukawa, Haruki Mori, Toru Miyake & Masaji Tani

Authors
  1. Hiromitsu Maehira
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  2. Hiroya Iida
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  3. Takashi Matsunaga
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  4. Daiki Yasukawa
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  5. Haruki Mori
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  6. Toru Miyake
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  7. Masaji Tani
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Contributions

Study conception and design: H. Maehira described and designed the manuscript. Acquisition of data: H. Maehira and T. Matsunaga reviewed the computed tomography findings and determined the volume of PFC. D. Yasukawa, H. Mori, T. Miyake, and T. Shimizu performed the surgery and postoperative management. Analysis and interpretation of data: H. Maehira. Drafting of manuscript: H. Maehira. Critical revision of manuscript: M. Tani and H. Iida revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiromitsu Maehira.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (ethics committee of the Shiga University of Medical Science (registration number 29-170)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Maehira, H., Iida, H., Matsunaga, T. et al. The location of perianastomotic fluid collection predicts postoperative complications after pancreaticoduodenectomy. Langenbecks Arch Surg 405, 325–336 (2020). https://doi.org/10.1007/s00423-020-01880-5

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