SSAT - PANCREATIC FISTULA OR LEAK AFTER DISTAL PANCREATECTOMY: HAS ANYTHING CHANGED? 13-YEAR SINGLE SURGEON EXPERIENC

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PANCREATIC FISTULA OR LEAK AFTER DISTAL PANCREATECTOMY: HAS ANYTHING CHANGED? 13-YEAR SINGLE SURGEON EXPERIENC
Anthony Morada^*, Pratik Mehta, Braden N. Miller, Alagappan A. Annamalai, Ashley Wachsman, Srinivas Gaddam, Laith H. Jamil, Simon K. Lo, Nicholas N. Nissen
Cedars-Sinai Medical Center, Los Angeles, CA

Background: Pancreatic fistula (PF) after distal pancreatectomy (DP) continues to pose a substantial clinical problem.
Objective: To evaluate a single-surgeon experience with PF following DP.
Design: Academic medical center. Review of surgical database. PF diagnosed by strict ISGPF criteria. Consecutive patient cohort evaluated in total and also as early (n=68) and late (n=68) cohorts.
Results: 136 patients underwent DP between 2003 and 2016. Pancreatic stump was managed by stapled (n=109) or pledgetted closure (n=23). Peri-pancreatic drains were used routinely. Patients in the more recent cohort were older (65 vs 60 years, P= 04), and were more likely to have adenocarcinoma (p=.04) and to undergo laparoscopic resection (p<.01). Overall morbidity and mortality were 27% and 1%. PF occurred in 44 patients (32%) including 21 grade A, 22 grade B, 1 grade C. In 21 patients with PF, surgical drainage provided definitive management with drain removal on mean post-op day 23. In the remaining 23 patients, either percutaneous drainage (n=11) or endoscopic transampullary stenting/cystgastrostomy (n=12) was utilized as salvage therapy. No particular risk factor for PF could be identified in multivariate analysis except concurrent colon resection (3 of 6 patients). PF rates did not differ between early and late groups, but the use of endoscopic therapy was more common in the later group (p=.03). Those undergoing endoscopic salvage therapies also had a trend towards requiring more overall interventions (mean 3.7 vs 2.2 in those managed with percutaneous therapy, p=.03).
Conclusion: Despite changes in the patient mix and surgical approach, the incidence of PF after DP has remained relatively constant. Endoscopic management of PF is increasing, although this may require more overall procedures. This approach should continue to be scrutinized.

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