Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases.
OBJECTIVE
The objective of this study was to identify potential risk factors for mortality and morbidity after distal pancreatectomy, with special focus on the formation of pancreatic fistula.


BACKGROUND
Distal pancreatectomy can be performed with low mortality and acceptable morbidity rates. Pancreatic fistulas, occurring in 10% to 20% of cases, remain a problem that contributes significantly to morbidity, length of stay, and overall costs.


METHODS
From November 1993 to February 2006, perioperative and postoperative data of 302 consecutive patients were recorded. Univariate and multivariate analyses of potential risk factors for morbidity and for the formation of pancreatic fistula were performed. The surgical techniques used for closure were categorized into 4 groups: 1) anastomosis, 2) seromuscular patch, 3) closure by suture, and 4) closure using a stapling device.


RESULTS
Indications for resection were pancreatic tumors in 62% of patients, nonpancreatic tumors in 23%, chronic pancreatitis in 12%, and others in 3%. The spleen was preserved in 24% of patients. The morbidity and mortality rates for distal pancreatectomy in this series were 35% and 2%, respectively. The prevalence of pancreatic fistula was 12%. Univariate and multivariate analyses indicated that closure using a stapling device and an operating time >or=480 minutes were associated with a higher incidence of pancreatic fistula (odds ratio = 2.6 and 4.2, respectively). Overall morbidity was mainly influenced by the extent of resection (multivisceral vs. conventional; odds ratio = 1.7).


CONCLUSIONS
Pancreatic leak remains a common complication after distal pancreatectomy. Our series suggests that stapler closure of the pancreatic remnant is associated with a significantly higher fistula rate.
Kleeff
Jörg
J
Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
Diener
Markus K
MK
Z'graggen
Kaspar
K
Hinz
Ulf
U
Wagner
Markus
M
Bachmann
Jeannine
J
Zehetner
Jörg
J
Müller
Michael W
MW
Friess
Helmut
H
Büchler
Markus W
MW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects; D017211:Treatment Failure