Results of Standard Stapler Closure of Pancreatic Remnant After Distal Spleno-Pancreatectomy for Adenocarcinoma

Frontiers in Surgery

article

Giulio Illuminati¹  Saverio Cerasari¹  Rocco Pasqua¹  Priscilla Nardi¹  Chiara Fratini¹  Sébastien Frey²  Antonio Iannelli²  Pierluigi Marini³ 

[1] The Department of Surgical Sciences, The University of Rome “La Sapienza”;The Department of Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice Archet, University of Cote d'Azur;The Department of General and Emergency Surgery, San Camillo–Forlanini Regional Hospital

关键词: distal pancreatectomy;    stapler closure;    pancreatic fistula;    adenocarcinoma;    pancreatic remnant;   

DOI  :  10.3389/fsurg.2020.596580

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background/Aim: The purpose of this study was to evaluate the results of stapled closure of the pancreatic remnant after cold-knife section of the pancreatic isthmus and distal pancreatectomy for adenocarcinoma. Methods: A retrospective evaluation of 57 consecutive patients undergoing distal spleno-pancreatectomy for adenocarcinoma was performed. The pancreatic isthmus was systematically straight-sectioned with a cold knife, and the remnant was stapled close without additional stitches or adjuncts. The study's main endpoints were postoperative mortality, the occurrence of a pancreatic fistula, the need for a re-operation, the postoperative length of stay in the hospital, the rate of re-admission, and late survival. Results: Postoperative mortality was absent. Seventeen patients (29.8%) presented a pancreatic fistula of grade A in seven cases (41.2%), grade B in eight cases (47.1%), and grade C in two cases (11.8%). Re-operation was required in the two patients (3.5%) with grade C fistula in order to drain an intra-abdominal abscess. The mean postoperative length of stay in the hospital was 15 days (range, 6–62 days). No patient required re-admission. Twenty-nine patients (50.8%) were alive and free from disease, respectively, 12 patients (21.1%) at 12 months, 13 patients (22.8%) at 60 months, and four patients (7.0%) at 120 months from the operation. The remaining patients died of metastatic disease 9–37 months from the operation. Lastly, disease-related mortality was 49.1%. Conclusion: Stapler closure of the pancreatic remnant allows good postoperative results, limiting the formation of pancreatic fistula to the lower limit of its overall reported incidence.

【 授权许可】

CC BY