International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Incidence and early prediction of post-operative pancreatic fistula after splenectomy in ovarian cancer cytoreduction within an enhanced recovery after surgery pathway: the ERASPLEEN study.
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D'Indinosante Marco, Bizzarri Nicolò, Zampolini Faustini Alice, Giannarelli Diana, Costantini Barbara, Naldini Angelica, Santullo Francesco, Lodoli Claudio, Cintoni Marco, Fanfani Francesco, Fagotti Anna
Аннотация
OBJECTIVE: To estimate the incidence of clinically relevant post-operative pancreatic fistula in patients undergoing splenectomy without a concurrent pancreatic procedure during cytoreductive surgery for advanced or recurrent ovarian cancer within an enhanced recovery after surgery protocol, and, secondarily, to describe the perioperative course and explore factors associated with grade B fistula.
METHODS: Prospective single-center phase II study. Post-operative pancreatic fistula was defined and graded per the 2016 International Study Group on Pancreatic Surgery criteria until post-operative day 30. Drain amylase and fluid output were recorded on post-operative day 3 and reassessed when abnormal. Pre-specified univariate and multi-variable analyses identified predictors of grade B fistula.
RESULTS: Ninety-two patients were included. Pancreatic-related events occurred in 9.8% (9/92): biochemical leak in 4 (4.3%) and grade B fistula in 5 (5.4%), with no grade C events. Median length of stay for the whole cohort was 7 days (interquartile range 6 to 9), but grade B fistula extended it to 18 days (interquartile range 13 to 26) (p < .001). Post-operative day 3 drain output was the only independent predictor of grade B fistula (odds ratio 1.41, 95%, confidence interval 1.12 to 1.79, p = .004).
CONCLUSIONS: Within an enhanced recovery after surgery pathway, grade B post-operative pancreatic fistula occurred in 5.4% of patients undergoing splenectomy without pancreatic resection. Post-operative day 3 drain output was the only independent predictor and may enable early identification of high-risk patients and safe early discharge for those with low output, pending prospective validation.
METHODS: Prospective single-center phase II study. Post-operative pancreatic fistula was defined and graded per the 2016 International Study Group on Pancreatic Surgery criteria until post-operative day 30. Drain amylase and fluid output were recorded on post-operative day 3 and reassessed when abnormal. Pre-specified univariate and multi-variable analyses identified predictors of grade B fistula.
RESULTS: Ninety-two patients were included. Pancreatic-related events occurred in 9.8% (9/92): biochemical leak in 4 (4.3%) and grade B fistula in 5 (5.4%), with no grade C events. Median length of stay for the whole cohort was 7 days (interquartile range 6 to 9), but grade B fistula extended it to 18 days (interquartile range 13 to 26) (p < .001). Post-operative day 3 drain output was the only independent predictor of grade B fistula (odds ratio 1.41, 95%, confidence interval 1.12 to 1.79, p = .004).
CONCLUSIONS: Within an enhanced recovery after surgery pathway, grade B post-operative pancreatic fistula occurred in 5.4% of patients undergoing splenectomy without pancreatic resection. Post-operative day 3 drain output was the only independent predictor and may enable early identification of high-risk patients and safe early discharge for those with low output, pending prospective validation.