Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer.
OBJECTIVE
To determine the incidence, management, and outcome of patients diagnosed with a pancreatic leak after a distal pancreatectomy during primary surgical cytoreduction for ovarian, peritoneal, or tubal cancer.


METHODS
We performed a retrospective chart review of all patients who had a distal pancreatectomy at the time of primary surgery. Charts were reviewed to identify those patients who developed a persistent left upper quadrant abdominal fluid collection with elevated amylase levels.


RESULTS
A total of 17 patients had a distal pancreatectomy; of these, 4 patients (24%) developed a postoperative pancreatic leak. In these patients, persistent leukocytosis prompted evaluation with a computed tomography scan, which subsequently revealed a fluid collection. The median time from surgery to drainage of this collection was 9 days (range, 8-66). The drain remained in situ for a median of 29 days (range, 22-82). The median amylase level of the fluid was 22,945 U/L (range, 763-47,250). The median length of hospital stay for those patients with a leak was 33 days (range, 25-44), which was longer than those without a leak. However, the median time from surgery to treatment with systemic chemotherapy was 31 days (range, 16-43), which was equivalent to those without a pancreatic leak.


CONCLUSIONS
Twenty-four percent of patients who had undergone a distal pancreatectomy developed a pancreatic leak. This complication, which usually presents early in the postoperative period, can be managed conservatively with percutaneous drainage. Oral intake may be resumed, and total parenteral nutrition is not needed in the majority of cases. Systemic chemotherapy can be administered without significant delay.
Kehoe
Siobhan M
SM
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI-1026, New York, NY 10021, USA.
Eisenhauer
Eric L
EL
Abu-Rustum
Nadeem R
NR
Sonoda
Yukio
Y
D'Angelica
Michael
M
Jarnagin
William R
WR
Barakat
Richard R
RR
Chi
Dennis S
DS
D000005:Abdomen / Q000473:pathology; D000328:Adult; D000368:Aged; D000681:Amylases / Q000378:metabolism; D001201:Ascites / Q000201:enzymology / Q000473:pathology; D004322:Drainage; D005185:Fallopian Tube Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology*; D010534:Peritoneal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects*
D000681:Amylases