Risk factors for pancreatic leak after distal pancreatectomy.

Published

Journal Article

INTRODUCTION: Pancreatic leak (PL) remains a major cause of postoperative morbidity in patients undergoing pancreatic resection. We sought to evaluate the incidence of and identify risk factors for the development of PL in patients undergoing distal pancreatectomy (DP) at a single high-volume institution. METHODS: All patients who underwent primary open DP (excluding completion pancreatectomy and debridement) between January 1, 1984 and July 1, 2006 were identified, and their medical records were reviewed. chi and multivariable logistic regression analyses were performed to identify risk factors for PL. RESULTS: In a cohort of 704 patients undergoing primary DP, the indications for DP were benign pancreatic neoplasm (34%), malignant pancreatic neoplasm (31%), other neoplasm (15%), chronic pancreatitis (14%), pseudocyst (3%), and trauma (3%). The pancreatic remnant was sutured alone in 83%, stapled alone in 5%, and both stapled and sutured in 9% of cases. Ligation of the pancreatic duct was performed in 22% of cases. Perioperative mortality was <1%, but overall morbidity was 33%, most commonly PL (12% clinically significant, 21% biochemical). Multivariable logistic regression analysis revealed that neither the method of closure of the pancreatic remnant (P = 0.41) nor ligation of the pancreatic duct (P > 0.05) affected the risk of clinically significant PL. CONCLUSIONS: This largest reported series of DP demonstrates that this procedure can be performed with low mortality but still carries a substantial risk of morbidity, particularly PL. In contrast to some previous studies, this analysis found that surgical management of the pancreatic remnant has no effect on the incidence of clinically significant PL.

Full Text

Duke Authors

Cited Authors

  • Nathan, H; Cameron, JL; Goodwin, CR; Seth, AK; Edil, BH; Wolfgang, CL; Pawlik, TM; Schulick, RD; Choti, MA

Published Date

  • August 2009

Published In

Volume / Issue

  • 250 / 2

Start / End Page

  • 277 - 281

PubMed ID

  • 19638926

Pubmed Central ID

  • 19638926

Electronic International Standard Serial Number (EISSN)

  • 1528-1140

International Standard Serial Number (ISSN)

  • 0003-4932

Digital Object Identifier (DOI)

  • 10.1097/sla.0b013e3181ae34be

Language

  • eng