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Pancreas Stump Closure Technique Affects Pancreatic Fistula Rate After Radical Distal Pancreatectomy
Roderich E. Schwarz*
IU Health Goshen Center for Cancer Care, Goshen, IN
Background: Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence after DP remain of interest.
Methods: Prospectively collected outcomes observed by a single surgeon in an academic surgical oncology practice were examined, and clinicopathologic and operative predictors of PF were analyzed.
Results: Seventy-two of 285 pancreatectomy patients underwent DP (25%). There were 30 men and 42 women with a median age of 61 years (range: 18-85). Underlying conditions included cancer (58%) and benign processes (42%). Resections were comprised of open DP (63%), laparoscopic DP (26%) and open multivisceral resections (11%). Spleen preservation was accomplished in 74%, despite planned splenic vascular resection in 93% of cases. Median operative blood loss was 250 ml, with 14% of patients receiving transfusions (50% for multivisceral, 9% for pancreas only resections). The mean lymph node count for cancer patients was 17.1 (+/- 10.4), with a R1 resection rate of 16%. Of 20 cases with postoperative complications (28%, no death), 6 were PFs (8%, 2 grade A and 4 grade B). The median LOS was 6 days (4-24). PF rate was 2.1% after sutured fish-mouth closures, but 21% after other techniques including stapling (p=0.007); no other variable was linked to PF occurrence. LOS was linked to complications, resection extent, underlying malignancy and transfusions (all at p<0.02) but not to PF.
Conclusion: PF rate after DP in this experience is unaffected by splenic vessel resection but appears to be minimized through a sutured fish-mouth closure technique.
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