J Korean Surg Soc. 2004 Sep;67(3):208-213. Korean.

Factors Associated with Morbidity and Mortality in Distal Pancreatectomy. Yu YD, Han HJ, Kim JM, Kim WB, Um JW, Mok YJ, Choi SY, Kim YC.
Department of Surgery, Korea University College of Medicine, Seoul, Korea. sschoi@korea.ac.kr Abstract PURPOSE: A pancreatic leak is a major source of morbidity associated with pancreatic surgery. A review of the indication for distal pancreatectomy and the disease and technique dependent factors associated with morbidity and mortality after this procedure were sought. METHODS: A retrospective analysis of the hospital records of all patients having undergone a distal pancreatectomy between January 1998 and December 2002 was prformed. The clinical, technical and pathological data were correlated with the operative morbidity or mortality. RESULTS: 95 patients had undergone a distal pancreatectomy. The male to female ratio of our series was 2.3 to 1, with a mean age of 54.2 years. 38 patients underwent the distal pancreatectomy for an intrapancreatic disease and 57 for an extrapancreatic disease, with a curative resection for stomach cancer the most common indication (47.4%). The clinicopathological and technical factors included the urgency of the operation, presence or absence of malignancy in the resected pancreas, method of pancreatic stump closure (suture vs. stapled) and the presence of a concomitant splenectomy. The morbidity and mortality rates were 27.3 and 2%, respectively. The postoperative complications included pancreatic fistula, intraabdominal abscess and wound infection among others. There were no factors significantly associated with the development of postoperative complications, especially pancreatic leakage. CONCLUSION: A distal pancreatectomy can be performed for a variety of benign and malignant conditions, with a low rate of mortality, although a pancreatic leak can be a serious cause of morbidity. The morbidity and pancreatic leakage rates in our study were 27.3 and 9.4%, respectively, but as there were no clinical or technical factors associated with pancreatic leakage in this retrospective analysis, it is propose that a prospective trial should be performed.

Morbidity, mortality, and technical factors of distal pancreatectomy

Bridget N Fahy, M.D.a, Charles F Frey, M.D.a, Hung S Ho, M.D.a, Laurel Beckett, Ph.D.b, Richard J Bold, M.D. , a, c,
a

Department of Surgery, University of California, Davis, Sacramento, CA, USA Epidemiology and Preventive Medicine, University of California, Davis, Sacramento, CA, USA c Division of Surgical Oncology, UC Davis Cancer Center, 4501 X St., Sacramento, CA 95817, USA
b

Abstract
Background: Pancreatic leak is a major source of morbidity associated with pancreatic surgery. We sought to identify disease and technique-dependent factors associated with morbidity and mortality after distal pancreatectomy. Methods: Retrospective review of patients who underwent distal pancreatectomy during a 5-year period. Clinical, technical, and pathologic data were correlated with operative morbidity or mortality. Results: Fifty-one patients underwent distal pancreatectomy for primary pancreatic disease, extrapancreatic malignancy, or trauma. Overall perioperative mortality and morbidity rates were 4% and 47%, respectively. Pancreatic leak was the most common complication, occurring in 26% of patients. Overall complications and pancreatic leaks occurred more often after distal pancreatectomy for trauma and in patients with a sutured pancreatic stump closure. Conclusions: Distal pancreatectomy can be performed with a low rate of mortality, though pancreatic leak is a common cause of morbidity. The urgency of the procedure and the method of pancreatic stump closure may influence postoperative morbidity.

Keywords

Pancreas;

Distal pancreatectomy; Pancreatic leak

Pancreatoenteral anastomosis or direct closure of the pancreatic remnant after a distal pancreatectomy: a single-centre experience.
Klein F, Glanemann M, Faber W, Gl S, Neuhaus P, Bahra M. Source Department of General, Visceral and Transplantation Surgery, Charit Campus Virchow, Universittsmedizin Berlin, Germany. fritz.klein@charite.de Abstract BACKGROUND: A major complication of a distal pancreatectomy (DP) is the formation of a postoperative pancreatic fistula (POPF). In spite of the utilization of numerous surgical techniques no consensus on an appropriate technique for closure of the pancreatic remnant after DP has been established yet. The aim of this study was to analyse the impact of pancreatoenteral anastomosis (PE) vs. direct closure (DC) of the pancreatic remnant on POPF. METHODS: A total of 198 consecutive patients who underwent a distal pancreatectomy between 2002 and 2010 at our institution were retrospectively analysed for post-operative morbidity and mortality. RESULTS: One hundred and fifty-one patients (76.3%) received DC whereas PE was performed in 47 patients (23.7%). The incidence of POPF was higher in the DC group (22% vs. 11%), whereas the rate of post-operative haemorrhage was higher in the PE group (11% vs. 7%). However, these differences were not significant. Additionally, there were no significant differences in overall post-operative morbidity and mortality between the groups. CONCLUSIONS: The performance of PE instead of DC may be considered as a safe alternative in individual patients, but it does not significantly lead to a general improvement in postoperative outcome after DP. An interdisciplinary collaboration in the prevention and treatment of POPF therefore remains essential.

 2012 International Hepato-Pancreato-Biliary Association. PMID: 23134180 [PubMed - in process] PMCID: PMC3521907 [Available on 2013/12/1]

Distal Pancreatectomy with En Bloc Celiac Axis Resection for the Treatment of Locally Advanced Pancreatic Body and Tail Cancer.
Jing W, Zhu G, Hu X, Jing G, Shao C, Zhou Y, He T, Zhang Y. Abstract Background/Aims: Pancreatic body and tail carcinoma (PBTC) is an aggressive disease with a low resectability rate. Celiac axis infiltration usually contraindicates resection. Extended distal pancreatectomy with combined en bloc celiac axis resection (DP-CAR, also named Appleby operation) was described as a new concept for the curative treatment of these tumors. The aim of this study was to analyze the results of DP-CAR in PBTC. Methodology: Analyze by summarizing the 24 cases of PBTC during October 2005 to August 2010 in the pancreatic surgery of our hospital and analyzing the clinical manifestations, surgical processing, pathological effects and survival rate of the patients. Results: The postoperative mortality rate was 0%, despite a high morbidity rate (54%). Preoperative intractable abdominal and/or back pain in all the patients was completely alleviated immediately after surgery. During the follow-up survey among all the patients of 2 to 37 months (with an average follow-up survey of 12.67 months), no patient was still alive, with the median survival of 9.25 months. Estimated overall 1- and 3-year survival rates were 46% and 4%, respectively. Conclusions: DP-CAR offers a high resectability rate without increasing the mortality rate given skilled surgical technique.