Abstract
Background/Aim: The purpose of this study was to evaluate the results of stapled closure of the pancreatic remnant after cold-knife section of the pancreatic isthmus and distal pancreatectomy for adenocarcinoma.Methods: A retrospective evaluation of 57 consecutive patients undergoing distal spleno-pancreatectomy for adenocarcinoma was performed. The pancreatic isthmus was systematically straight-sectioned with a cold knife, and the remnant was stapled close without additional stitches or adjuncts. The study's main endpoints were postoperative mortality, the occurrence of a pancreatic fistula, the need for a re-operation, the postoperative length of stay in the hospital, the rate of re-admission, and late survival.Results: Postoperative mortality was absent. Seventeen patients (29.8%) presented a pancreatic fistula of grade A in seven cases (41.2%), grade B in eight cases (47.1%), and grade C in two cases (11.8%). Re-operation was required in the two patients (3.5%) with grade C fistula in order to drain an intra-abdominal abscess. The mean postoperative length of stay in the hospital was 15 days (range, 6–62 days). No patient required re-admission. Twenty-nine patients (50.8%) were alive and free from disease, respectively, 12 patients (21.1%) at 12 months, 13 patients (22.8%) at 60 months, and four patients (7.0%) at 120 months from the operation. The remaining patients died of metastatic disease 9–37 months from the operation. Lastly, disease-related mortality was 49.1%.Conclusion: Stapler closure of the pancreatic remnant allows good postoperative results, limiting the formation of pancreatic fistula to the lower limit of its overall reported incidence.
Highlights
The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy varies from 10 to 40% [1,2,3,4,5,6,7,8,9,10,11]
Specialty section: This article was submitted to Visceral Surgery, a section of the journal
Background/Aim: The purpose of this study was to evaluate the results of stapled closure of the pancreatic remnant after cold-knife section of the pancreatic isthmus and distal pancreatectomy for adenocarcinoma
Summary
The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy varies from 10 to 40% [1,2,3,4,5,6,7,8,9,10,11]. No conclusive evidence of superiority of a technique over the others is really available, and a recent study concluded that the rate of POPF after distal spleno-pancreatectomy (DP) is probably independent of the technique of pancreatic closure [13] Such variability in results and rate of fistula formation may be related both to technical factors and to patient-related variables, including American Society of Anesthesiologists (ASA) score, body mass index (BMI)/overweight, diabetes, hypoalbuminemia, pancreatic thickness, indication for operation (invasive ductal carcinoma, pancreatitis, neuroendocrine tumors), level of pancreatic transection, length, and complexity of operation, associated splenectomy, and intra-operative bleeding [12, 23,24,25,26]
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