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Risk factors for pancreatic leak after distal pancreatectomy.

Publication ,  Journal Article
Nathan, H; Cameron, JL; Goodwin, CR; Seth, AK; Edil, BH; Wolfgang, CL; Pawlik, TM; Schulick, RD; Choti, MA
Published in: Ann Surg
August 2009

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.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

August 2009

Volume

250

Issue

2

Start / End Page

277 / 281

Location

United States

Related Subject Headings

  • Young Adult
  • Suture Techniques
  • Surgery
  • Sex Factors
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Pancreatic Diseases
  • Pancreatectomy
  • Middle Aged
 

Citation

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Nathan, H., Cameron, J. L., Goodwin, C. R., Seth, A. K., Edil, B. H., Wolfgang, C. L., … Choti, M. A. (2009). Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg, 250(2), 277–281. https://doi.org/10.1097/SLA.0b013e3181ae34be
Nathan, Hari, John L. Cameron, Courtney R. Goodwin, Akhil K. Seth, Barish H. Edil, Christopher L. Wolfgang, Timothy M. Pawlik, Richard D. Schulick, and Michael A. Choti. “Risk factors for pancreatic leak after distal pancreatectomy.Ann Surg 250, no. 2 (August 2009): 277–81. https://doi.org/10.1097/SLA.0b013e3181ae34be.
Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, et al. Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg. 2009 Aug;250(2):277–81.
Nathan, Hari, et al. “Risk factors for pancreatic leak after distal pancreatectomy.Ann Surg, vol. 250, no. 2, Aug. 2009, pp. 277–81. Pubmed, doi:10.1097/SLA.0b013e3181ae34be.
Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, Pawlik TM, Schulick RD, Choti MA. Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg. 2009 Aug;250(2):277–281.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

August 2009

Volume

250

Issue

2

Start / End Page

277 / 281

Location

United States

Related Subject Headings

  • Young Adult
  • Suture Techniques
  • Surgery
  • Sex Factors
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Pancreatic Diseases
  • Pancreatectomy
  • Middle Aged