Peripancreatic Fluid Collections Following Distal Pancreatectomy and Splenectomy – When Is Intervention Warranted?

Abstract

BackgroundPeripancreatic fluid collections following distal pancreatectomy and splenectomy are commonly identified on postoperative cross-sectional imaging. This study aims to determine the incidence, natural history, and indications for intervention. MethodsWe conducted a retrospective review of patients with peripancreatic fluid collections following distal pancreatectomy with or without splenectomy between 2013 and 2018, approved by our institutional review board. The chi-square test was used for categorical variables, the Mann-Whitney U test for continuous variables, and Fisher's exact test was used for values where the sample size was less than five to compare data. ResultsDuring the study period, 235 patients underwent distal pancreatectomy with or without splenectomy, and 182 patients with postoperative imaging were included. In the cohort of patients with postoperative imaging, 83 (46%) had peripancreatic fluid collections, of which 46 (55%) were symptomatic fluid collections (SFC) and 37 (45%) were asymptomatic fluid collections (AFC). Those with SFC had a higher incidence of postoperative morbidity (46% vs. 8%, p=0.0002), most commonly postoperative pancreatic fistula (90%). Of patients with SFC, 34 (74%) underwent treatment via percutaneous drainage (n=26), endoscopic drainage (n=7), or antibiotics alone (n=1). AFC (n=37) were observed. Collections that were intervened upon resolved significantly faster than those observed, 3.5 months vs 13.2 months (p<0.0001), respectively. ConclusionsAsymptomatic patients may be observed with or without serial imaging and the AFC will typically resolve spontaneously with time. Patients who develop symptoms should generally be intervened upon with drainage if deemed feasible, as this reduces the time to resolution.