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Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the incidence, predictors and clinical outcome of pancreatic fistulas in patients receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer.

Methods

Data of women who underwent splenectomy during cytoreduction for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Surgical, post-operative and follow-up data were analysed.

Results

Overall, 260 patients were included in the study. Pancreatic resection was performed in 45 (17.6%) women, 23 of whom received capsule resection alone, while 22 required tail resection. Hyperthermic intraperitoneal chemotherapy (HIPEC) was administered in 28 (10.8%) patients. In the overall population, a pancreatic fistula was detected in 32 (12.3%) patients, and pancreatic resection (p-value = 0.033) and HIPEC administration (p-value = 0.039) were associated with fistula development. In multivariate analysis, HIPEC (OR = 2.573; p-value = 0.058) was confirmed as a risk factor for fistula development in women receiving splenectomy alone, while concomitant cholecystectomy (OR = 2.680; p-value = 0.012) was identified as the only independent predictor of the occurrence of pancreatic fistulas in those receiving additional distal pancreatectomy. Although the median length of hospital stay was higher in women with pancreatic leakage (p-value = 0.008), the median time from surgery to adjuvant treatment was not significantly increased.

Conclusion

HIPEC was identified as a risk factor for pancreatic fistulas in patients who underwent splenectomy alone, while concomitant cholecystectomy was the only independent predictor of fistula in those receiving additional pancreatectomy. The development of pancreatic leakage was not associated with increased post-operative mortality or delay in the initiation of chemotherapy.

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Acknowledgements

We would like to thank all the members of the staff of the Department of Gynecologic Oncology, University of Palermo, Palermo, Italy; The Division of Gynecologic Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Catholic University of the Sacred Heart, Campobasso, Italy; The Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; The Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain; and The Department of Gynaecology and Obstetrics, University of Parma, Parma, Italy.

Funding

All authors declare they have no funding.

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Authors and Affiliations

  1. Department of Gynecologic Oncology, University of Palermo, Palermo, Italy

    Giulio Sozzi, Giuseppe Paci, Giulia Musicò, Mariano Catello Di Donna & Vito Chiantera

  2. Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy

    Marco Petrillo

  3. Biomedical Sciences, University of Sassari, Sassari, Italy

    Marco Petrillo

  4. Department of Gynaecology and Obstetrics, University of Parma, Parma, Italy

    Roberto Berretta & Vito Andrea Capozzi

  5. Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Virginia Vargiu, Federica Bernardini, Anna Fagotti & Giovanni Scambia

  6. Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain

    Victor Lago & Santiago Domingo

Authors
  1. Giulio Sozzi
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  2. Marco Petrillo
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  3. Roberto Berretta
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  13. Giovanni Scambia
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Correspondence to Giulio Sozzi.

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

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

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Sozzi, G., Petrillo, M., Berretta, R. et al. Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience. Arch Gynecol Obstet 302, 707–714 (2020). https://doi.org/10.1007/s00404-020-05684-2

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  • DOI: https://doi.org/10.1007/s00404-020-05684-2

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