Abstract
Background
Pancreatic fistula (PF) represents a major complication after distal pancreatectomy.
In a consecutive series of 110 patients, risk factors for the incidence of PF and
surgical morbidity were identified.
Methods
Patients having undergone distal pancreatectomy between 2003 and 2007 were identified.
Clinicopathologic parameters as well as perioperative data were correlated with the
incidence of PF and overall surgical morbidity using univariate and multivariate models.
Results
In 72 patients (65%), malignant disease was present. Splenectomy and multivisceral
resection were performed in 84 (76%) and 47 (42%) patients, respectively. Overall
major surgical morbidity was 18%, and 12 patients (11%) developed PFs. A body mass
index > 25 kg/m2 was the only independent significant predictive factor for PF. Malignancy, splenectomy,
multivisceral resection, transfusion, comorbidity, and stapler use did not show statistical
significance. For overall surgical morbidity, there was no significant indicator.
Conclusions
A body mass index > 25 kg/m2 contributes to the incidence of PF after distal pancreatectomy. Other parameters
did not show a significant influence on PF or on overall surgical morbidity.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands.Ann Surg. 2005; 242: s781-s790
- Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy.Arch Surg. 2003; 138: 1310-1315
- Hospital volume and surgical mortality in the United States.N Engl J Med. 2002; 346: 1128-1137
- Morbidity, mortality, and technical factors of distal pancreatectomy.Am J Surg. 2002; 183: 237-241
- Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients.J Am Coll Surg. 2007; 205: 52-59
- Distal pancreatectomy for chronic pancreatitis: risk factors for postoperative pancreatic fistula.J Gastrointest Surg. 2007; 11: 991-997
- Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment.Arch Surg. 2006; 141: 1071-1076
- Distal pancreatectomy: indications and outcomes in 235 patients.Ann Surg. 1999; 229: 693-700
- Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases.Ann Surg. 2007; 245: 573-582
- Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients.Ann Surg. 2002; 236: 612-618
- Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme.Ann Surg. 2007; 245: 443-451
- Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy.Surgery. 2005; 137: 180-185
- Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution.J Gastrointest Surg. 2008; 12: 270-278
- Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial.Arch Surg. 2004; 139: 288-295
- The value of splenic preservation with distal pancreatectomy.Arch Surg. 2002; 137: 164-168
- Distal pancreatectomy with splenic preservation revisited.Surgery. 2007; 141: 619-625
- A single-institution prospective study of laparoscopic pancreatic resection.Arch Surg. 2008; 143: 289-295
- Safe and quick distal pancreatectomy using a staggered six-row stapler.Am J Surg. 2008; 195: 115-118
- Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients.Ann Surg. 2007; 246: 77-82
- Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients.Surgery. 2005; 137: 597-605
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy.Br J Surg. 2005; 92: 539-546
- Risk prediction for development of pancreatic fistula using the ISGPF classification scheme.World J Surg. 2008; 32: 419-428
- Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. 2005; 138: 8-13
- Influence of mild obesity on outcome of simultaneous pancreas and kidney transplantation.J Gastrointest Surg. 2003; 7: 1096-1101
- Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study.Int J Colorectal Dis. 2008; 23: 265-270
- Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.Lancet. 2008; 371: 569-578
- POSSUM accurately predicts morbidity for pancreatic resection.Surgery. 2008; 143: 8-19
- POSSUM: a scoring system for surgical audit.Br J Surg. 1991; 78: 355-360
- Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital.Hepatogastroenterology. 2002; 49: 1124-1129
- Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula.J Gastrointest Surg. 2004; 8: 951-959
- Distal pancreatectomy in chronic pancreatitis.Dig Surg. 1999; 16: 130-136
Article info
Publication history
Published online: April 12, 2010
Received in revised form:
October 21,
2009
Received:
May 30,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
