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Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler

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Abstract

Purpose

No consistent risk factor has yet been established for the development of pancreatic fistula (PF) after distal pancreatectomy (DP) with a stapler.

Methods

A total of 31 consecutive patients underwent DP with an endopath stapler between June 2006 and December 2010 using a slow parenchymal flattening technique. The risk factors for PF after DP with an endopath stapler were identified based on univariate and multivariate analyses.

Results

Clinical PF developed in 7 of 31 (22 %) patients who underwent DP with a stapler. The pancreata were significantly thicker at the transection line in patients with PF (19.4 ± 1.47 mm) in comparison to patients without PF (12.6 ± 0.79 mm; p = 0.0003). A 16-mm cut-off for pancreatic thickness was established based on the receiver operating characteristic (ROC) curve; the area under the ROC curve was 0.875 (p = 0.0215). Pancreatic thickness (p = 0.0006) and blood transfusion (p = 0.028) were associated with postoperative PF in a univariate analysis. Pancreatic thickness was the only significant independent factor (odds ratio 9.99; p = 0.036) according to a multivariate analysis with a specificity of 72 %, and a sensitivity of 85 %.

Conclusion

Pancreatic thickness is a significant independent risk factor for PF development after DP with an endopath stapler. The stapler technique is thus considered to be an appropriate modality in patients with a pancreatic thicknesses of <16 mm.

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Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Keiichi Okano, Minoru Oshima, Keitaro Kakinoki, Naoki Yamamoto, Shintaro Akamoto, Shinichi Yachida, Masanobu Hagiike & Yasuyuki Suzuki

  2. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Hideki Kamada & Tsutomu Masaki

Authors
  1. Keiichi Okano
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  2. Minoru Oshima
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  3. Keitaro Kakinoki
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  10. Yasuyuki Suzuki
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Correspondence to Keiichi Okano.

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Okano, K., Oshima, M., Kakinoki, K. et al. Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler. Surg Today 43, 141–147 (2013). https://doi.org/10.1007/s00595-012-0235-4

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  • DOI: https://doi.org/10.1007/s00595-012-0235-4

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