Annals of surgery · 2025
Pancreatic Fistula and Intra-abdominal Fluid Collections After Distal Pancreatectomy: Incidence, Implications, and Natural History.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Pitakteerabundit Thakerng, Fagenholz Peter J, Luckhurst Casey M, Srinivas Rao Shravya, Kambadakone Avinash, Warshaw Andrew L, Lillemoe Keith D, Qadan Motaz, Fernandez-Del Castillo Carlos
Аннотация
OBJECTIVE: To investigate the incidence and management of pancreatic fistula and fluid collections (FCs) after distal pancreatectomy (DP).
BACKGROUND: Pancreatic fistula and FC are common after DP. The relationship between pancreatic fistula, FC, and surgical drain placement remains unclear.
METHODS: We retrospectively reviewed patients who underwent DP at a single institution between June 2000 and August 2023.
RESULTS: In total, 1212 patients were reviewed. Among them, 300 (24.9%) developed a biochemical leak, and 162 (13.4%) developed a postoperative pancreatic fistula (POPF). Of the 949 patients who had at least 1 postoperative cross-sectional imaging, 500 (52.7%) had an FC. Most FCs were asymptomatic (68%); however, when associated with POPF, the majority (n=121, 89%) became symptomatic and required treatment. Patients with POPF were significantly more likely to develop FC (OR 9.49), whereas biochemical leakage did not significantly increase this risk. Surgical drains did not significantly decrease the likelihood of FC (52% vs 66%, P =0.06), but did increase POPF (13.9% vs 4.7%, P <0.001) and the need for intervention for FC (33.6% vs 12.9%, P =0.019).
CONCLUSIONS: FC develop in over half of the patients undergoing DP, with approximately one fourth of these cases associated with POPF. In most instances, FC remain asymptomatic; however, when linked to POPF, they are nine times more likely to become symptomatic and require therapeutic intervention. Although surgical drain placement may not contribute to FC, it was associated with a higher rate of POPF.
BACKGROUND: Pancreatic fistula and FC are common after DP. The relationship between pancreatic fistula, FC, and surgical drain placement remains unclear.
METHODS: We retrospectively reviewed patients who underwent DP at a single institution between June 2000 and August 2023.
RESULTS: In total, 1212 patients were reviewed. Among them, 300 (24.9%) developed a biochemical leak, and 162 (13.4%) developed a postoperative pancreatic fistula (POPF). Of the 949 patients who had at least 1 postoperative cross-sectional imaging, 500 (52.7%) had an FC. Most FCs were asymptomatic (68%); however, when associated with POPF, the majority (n=121, 89%) became symptomatic and required treatment. Patients with POPF were significantly more likely to develop FC (OR 9.49), whereas biochemical leakage did not significantly increase this risk. Surgical drains did not significantly decrease the likelihood of FC (52% vs 66%, P =0.06), but did increase POPF (13.9% vs 4.7%, P <0.001) and the need for intervention for FC (33.6% vs 12.9%, P =0.019).
CONCLUSIONS: FC develop in over half of the patients undergoing DP, with approximately one fourth of these cases associated with POPF. In most instances, FC remain asymptomatic; however, when linked to POPF, they are nine times more likely to become symptomatic and require therapeutic intervention. Although surgical drain placement may not contribute to FC, it was associated with a higher rate of POPF.