Faculty Collaboration Database

Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 2003 Feb;90(2):190-6

Date

01/30/2003

Pubmed ID

12555295

DOI

10.1002/bjs.4032

Scopus ID

2-s2.0-0037326548 (requires institutional sign-in at Scopus site)   211 Citations

Abstract

BACKGROUND: Although much is known about the long-term outcome of patients undergoing left (distal) pancreatectomy for malignancy, comparatively little is known about the optimal management strategy for the residual transected pancreatic parenchyma and the divided pancreatic duct. Clinicopathological and operative factors that may contribute to postoperative pancreatic leak were evaluated.

METHODS: A retrospective review of the medical records of 126 patients who underwent left pancreatectomy between June 1990 and December 1999 at the University of Texas M. D. Anderson Cancer Center was performed.

RESULTS: Indications for left pancreatectomy included pancreatic neoplasms (n = 42; 33.3 per cent), en bloc resection for management of retroperitoneal sarcoma (n = 21; 16.7 per cent), gastric adenocarcinoma (n = 14; 11.1 per cent), renal cell carcinoma (n = 11; 8.7 per cent) and other tumours or benign conditions (n = 38; 30.2 per cent). Pancreatic parenchymal closure was accomplished by a hand-sewn technique, mechanical stapling, or a combination of the two in 83, 20 and 15 patients respectively. No form of parenchymal closure was used in eight patients. Identification of the pancreatic duct and suture ligation was performed in 73 patients (57.9 per cent). Twenty-five patients (19.8 per cent) developed a pancreatic leak. For subgroups having duct ligation or no duct ligation, pancreatic leak rates were 9.6 per cent (seven of 73 patients) and 34.0 per cent (18 of 53 patients) respectively (P < 0.001). Multivariate analysis including clinicopathological and operative factors indicated that failure to ligate the pancreatic duct was the only feature associated with an increased risk for pancreatic leak (odds ratio 5.0 (95 per cent confidence interval 2.0 to 10.0); P = 0.001).

CONCLUSION: Pancreatic leak remains a common complication after left pancreatectomy. The incidence of leak is reduced significantly when the pancreatic duct is identified and directly ligated during left pancreatectomy.

Author List

Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Renal Cell
Child
Child, Preschool
Female
Humans
Ligation
Lymph
Male
Middle Aged
Pancreatectomy
Pancreatic Ducts
Pancreatic Neoplasms
Postoperative Complications
Prospective Studies
Retroperitoneal Neoplasms
Retrospective Studies
Sarcoma
Stomach Neoplasms