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Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection.

ABSTRACT: Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

SUBMITTER: Maeda K

PROVIDER: S-EPMC8577730 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection.

Maeda Koki K Kuriyama Naohisa N Nakagawa Yuki Y Ito Takahiro T Hayasaki Aoi A Gyoten Kazuyuki K Fujii Takehiro T Iizawa Yusuke Y Murata Yasuhiro Y Tanemura Akihiro A Kishiwada Masashi M Sakurai Hiroyuki H Mizuno Shugo S

PloS one 20211109 11

Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal ...[more]

PMID: 34752498

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Project description:BackgroundHighly utilized risk scores for clinically relevant postoperative pancreatic fistula (CR-POPF) have guided clinical decision-making in pancreatoduodenectomy. However, none has been successfully developed for distal pancreatectomy. This study aimed to develop and validate a new fistula risk score for distal pancreatectomy.MethodsPatients undergoing distal pancreatectomy at Helsinki University Hospital, Finland from 2013 to 2021, and at Karolinska University Hospital, Sweden, from 2010 to 2020, were included retrospectively. The outcome was CR-POPF, according to the 2016 International Study Group of Pancreatic Surgery definition. Preoperative clinical demographics and radiological parameters such as pancreatic thickness and duct diameter were measured. A logistic regression model was developed, internally validated with bootstrapping, and the performance assessed in an external validation cohort.ResultsOf 668 patients from Helsinki (266) and Stockholm (402), 173 (25.9 per cent) developed CR-POPF. The final model consisted of three variables assessed before surgery: transection site (neck versus body/tail), pancreatic thickness at transection site, and diabetes. The model had an area under the receiver operating characteristic curve (AUROC) of 0.904 (95 per cent c.i. 0.855 to 0.949) after internal validation, and 0.798 (0.748 to 0.848) after external validation. The calibration slope and intercept on external validation were 0.719 and 0.192 respectively. Four risk groups were defined in the validation cohort for clinical applicability: low (below 5 per cent), moderate (at least 5 but below 30 per cent), high (at least 30 but below 75 per cent), and extreme (75 per cent or more). The incidences in these groups were 8.7 per cent (11 of 126), 22.0 per cent (36 of 164), 63 per cent (57 of 91), and 81 per cent (17 of 21) respectively.ConclusionThe DISPAIR score after distal pancreatectomy may guide decision-making and allow a risk-adjusted outcome comparison for CR-POPF.

Project description:BackgroundTo evaluate the efficacy and safety of a modified pancreatic remnant-gastric coverage technique in laparoscopic distal pancreatectomy (LDP).MethodsThis retrospective study analyzed clinical data from 63 patients who underwent LDP between March 2017 and April 2024 at the Hepatobiliary and Pancreatic Surgery Department, The Affiliated LiHuiLi Hospital of Ningbo University. Patients were divided into two groups based on the pancreatic remnant management method: the experimental group (n = 28) underwent pancreatic remnant-gastric coverage, while the control group (n = 35) had the pancreatic remnant closed using a stapler followed by hand-sewn reinforcement. The parameters observed included general patient characteristics, intraoperative data, and postoperative data. We compared and analyzed all the above data between the two groups of patients both before and after propensity score matching (PSM).ResultsAll 63 patients were successfully operated. Before PSM, the incidence of POPF (Grade B/C) in the experimental group was significantly lower than in the control group (14.3% vs 34.3%, P < 0.05). And the incidence of POPF (BL) in the experimental group was lower than in the control group (39.3% vs 51.4%). After PSM, the difference in the incidence of POPF (Grade B/C) between the two groups remained statistically significant (16.0% vs 32.0%, P < 0.05). The incidence of POPF (BL) in the experimental group was also lower than in the control group (36.0% vs 56.0%). There were no statistically significant differences between the two groups in terms of operation time, pancreatic texture, thickness of pancreatic stump, intraoperative bleeding, intraoperative transfusion, post-pancreatectomy hemorrhage, abdominal infection, encapsulated effusion, or delayed gastric emptying both before and after PSM (P > 0.05).ConclusionThe use of the modified pancreatic remnant-gastric coverage in LDP effectively reduces the incidence of POPF and is both safe and feasible, making it a technique worth promoting.

Dataset Information

Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection.

Publications

Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection.

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