Analysis of Risk Factors for Pancreatic Fistula after Distal Pancreatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGHao , TANChun-lu ,  LIKe-zhou

Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

LIKe-zhou, Email: huaxipancreas@163.com

Keywords：

Distal pancreatectomy; Pancreatic fistula; Operation

DOI：

10.7507/1007-9424.20160050

Video：

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Objective To explore risk factors for pancreatic fistula and severe pancreatic fistula (grade B and C) after distal pancreatectomy. Methods One hundred and fifty patients underwent distal pancreatectomy were collected and analyzed from January 2012 to December 2014 in this retrospective study,among which 61 cases were male,89 cases were female,age from 18 to 78 years old.The risk factors for pancreatic fistula and severe pancreatic fistula after distal pancreatectomy were analyzed by univariate and multivariate logistic regression analysis. Results In these patients,136 cases were underwent laparotomy,8 cases were underwent total laparoscopic surgery,6 cases were underwent hand assisted laparoscopic surgery;39 cases were preserved spleen,111 cases were combined splenectomy.Technique for closure of the pancreas remnant,15 cases were used cut stapler (Echelon 60,EC60),77 cases were used cut stapler (Echelon 60,EC60) combined with manual suture,52 cases were underwent manual cut and suture,and 6 cases were underwent pancreatic stump jejunum anastomosis.The total incidence of complications was 36.0%(54/150),the postoperative hospitalization time was (9.1±6.2) d,the reoperation rate was 2.7%(4/150),the perioperative mortality was 0,the incidence of postoperative pancreatic fistula was 34.7%(grade B and C was 10.0%).In these patients with postoperative pancreatic fistula,the postoperative hospitalization time was (12.6±9.3) d,the reoperation rate was 7.7%(4/52).The results of the univariate and multivariate logistic regression analysis showed that the hypoproteinemia (OR=4.919,P<0.05) was the risk factor for pancreatic fistula after distal pancreatectomy,the malignancy (OR=4.125,P<0.05) was the risk factor for severe pancreatic fistula after distal pancreatectomy. Conclusions Incidence of pancreatic fistula after distal pancreatectomy is related to hypoproteinemia before operation,it is needed to improve the nutritional status by nutrition treatment for reducing postoperative pancreatic fistula.If patient with malignancy has postoperative pancreatic fistula,it is likely to be severe pancreatic fistula.

Citation： ZHANGHao, TANChun-lu, LIKe-zhou. Analysis of Risk Factors for Pancreatic Fistula after Distal Pancreatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 192-197. doi: 10.7507/1007-9424.20160050 Copy

1.	Yoshioka R, Saiura A, Koga R, et al. Risk factors for clinical pancre-atic fistula after distal pancreatectomy:analysis of consecutive 100 patients. World J Surg, 2010, 34(1):121-125.
2.	Unek T, Egeli T, Ozbilgin M, et al. Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy. Hepatogastroenterology, 2013, 60(127):1778-1784.
3.	Makni A, Rebai W, Daghfouss A, et al. Risk factors associated with pancreatic fistula after distal pancreatectomy. Tunis Med, 2012, 90(2):148-153.
4.	Ban D, Shimada K, Konishi M, et al. Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy:multicenter retrospective analysis of 388 patients. World J Surg, 2012, 36(8):1866-1873.
5.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
6.	Clark OH, Benson AB, Berlin JD, et al. NCCN clinical practice guidelines in oncology:neuroendocrine tumors. J Natl Compr Canc Netw, 2009, 7(7):712-747.
7.	Oberstein PE, Remotti H, Saif MW, et al. Pancreatic neuroendocrine tumors:entering a new era. JOP, 2012, 13(2):169-173.
8.	Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg, 2005, 92(5):539-546.
9.	Schoellhammer HF, Fong Y, Gagandeep S. Techniques for preven-tion of pancreatic leak after pancreatectomy. Hepatobiliary Surg Nutr, 2014, 3(5):276-287.
10.	Mcmillan MT, Vollmer CM. Predictive factors for pancreatic fistula following pancreatectomy. Langenbecks Arch Surg, 2014, 399(7):811-824.
11.	Zhang H, Zhu F, Shen M, et al. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg, 2015, 102(1):4-15.
12.	Hackert T, Büchler MW. Remnant closure after distal pancreatec* tomy:current state and future perspectives. Surgeon, 2012, 10(2):95-101.
13.	Wallace CL, Georgakis GV, Eisenberg DP, et al. Further experience with pancreatic stump closure using a reinforced staple line. Conn Med, 2013, 77(4):205-210.
14.	Sugimoto M, Gotohda N, Kato Y, et al. Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancrea-tectomy with stapler use. J Hepatobiliary Pancreat Sci, 2013, 20(5):538-544.
15.	Kawai M, Tani M, Okada K, et al. Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancrea-tectomy. Am J Surg, 2013, 206(3):352-359.
16.	Klein F, Glanemann M, Faber W, et al. Pancreatoenteral anastomosis or direct closure of the pancreatic remnant after a distal pancreatec tomy:a single-centre experience. HPB (Oxford), 2012, 14(12):798-804.
17.	Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas:it's time to randomize. Surgery, 2015, 157(1):45-55.
18.	Wang H, Xiu D, Jiang B, et al. Postoperative pancreatic fistula in distal pancreatectomy:experience from 1 institution. Pancreas, 2014, 43(4):588-591.
19.	Rostas JW, Richards WO, Thompson LW. Improved rate of pancr-eatic fistula after distal pancreatectomy:parenchymal division with the use of saline-coupled radiofrequency ablation. HPB (Oxford), 2012, 14(8):560-564.
20.	Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatec-tomy:a systematic review of comparative studies. Surg Endosc, 2012, 26(4):904-913.
21.	Lee SE, Jang JY, Lee KU, et al. Clinical comparison of distal pancreatectomy with or without splenectomy. J Korean Med Sci, 2008, 23(6):1011-1014.

1. Yoshioka R, Saiura A, Koga R, et al. Risk factors for clinical pancre-atic fistula after distal pancreatectomy:analysis of consecutive 100 patients. World J Surg, 2010, 34(1):121-125.
2. Unek T, Egeli T, Ozbilgin M, et al. Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy. Hepatogastroenterology, 2013, 60(127):1778-1784.
3. Makni A, Rebai W, Daghfouss A, et al. Risk factors associated with pancreatic fistula after distal pancreatectomy. Tunis Med, 2012, 90(2):148-153.
4. Ban D, Shimada K, Konishi M, et al. Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy:multicenter retrospective analysis of 388 patients. World J Surg, 2012, 36(8):1866-1873.
5. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
6. Clark OH, Benson AB, Berlin JD, et al. NCCN clinical practice guidelines in oncology:neuroendocrine tumors. J Natl Compr Canc Netw, 2009, 7(7):712-747.
7. Oberstein PE, Remotti H, Saif MW, et al. Pancreatic neuroendocrine tumors:entering a new era. JOP, 2012, 13(2):169-173.
8. Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg, 2005, 92(5):539-546.
9. Schoellhammer HF, Fong Y, Gagandeep S. Techniques for preven-tion of pancreatic leak after pancreatectomy. Hepatobiliary Surg Nutr, 2014, 3(5):276-287.
10. Mcmillan MT, Vollmer CM. Predictive factors for pancreatic fistula following pancreatectomy. Langenbecks Arch Surg, 2014, 399(7):811-824.
11. Zhang H, Zhu F, Shen M, et al. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg, 2015, 102(1):4-15.
12. Hackert T, Büchler MW. Remnant closure after distal pancreatec* tomy:current state and future perspectives. Surgeon, 2012, 10(2):95-101.
13. Wallace CL, Georgakis GV, Eisenberg DP, et al. Further experience with pancreatic stump closure using a reinforced staple line. Conn Med, 2013, 77(4):205-210.
14. Sugimoto M, Gotohda N, Kato Y, et al. Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancrea-tectomy with stapler use. J Hepatobiliary Pancreat Sci, 2013, 20(5):538-544.
15. Kawai M, Tani M, Okada K, et al. Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancrea-tectomy. Am J Surg, 2013, 206(3):352-359.
16. Klein F, Glanemann M, Faber W, et al. Pancreatoenteral anastomosis or direct closure of the pancreatic remnant after a distal pancreatec tomy:a single-centre experience. HPB (Oxford), 2012, 14(12):798-804.
17. Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas:it's time to randomize. Surgery, 2015, 157(1):45-55.
18. Wang H, Xiu D, Jiang B, et al. Postoperative pancreatic fistula in distal pancreatectomy:experience from 1 institution. Pancreas, 2014, 43(4):588-591.
19. Rostas JW, Richards WO, Thompson LW. Improved rate of pancr-eatic fistula after distal pancreatectomy:parenchymal division with the use of saline-coupled radiofrequency ablation. HPB (Oxford), 2012, 14(8):560-564.
20. Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatec-tomy:a systematic review of comparative studies. Surg Endosc, 2012, 26(4):904-913.
21. Lee SE, Jang JY, Lee KU, et al. Clinical comparison of distal pancreatectomy with or without splenectomy. J Korean Med Sci, 2008, 23(6):1011-1014.

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Analysis of Risk Factors for Pancreatic Fistula after Distal Pancreatectomy

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