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. 2016 Jan;18(1):35-40.
doi: 10.1016/j.hpb.2015.10.006. Epub 2015 Nov 18.

Fluid collection after distal pancreatectomy: a frequent finding

Christin Tjaden  1 , Ulf Hinz  1 , Matthias Hassenpflug  1 , Franziska Fritz  2 , Stefan Fritz  1 , Lars Grenacher  3 , Markus W Büchler  1 , Thilo Hackert  4
Affiliations

Fluid collection after distal pancreatectomy: a frequent finding

Christin Tjaden et al. HPB (Oxford). 2016 Jan.

Abstract

Background: Fluid collections (FC) at the resection margin of the pancreatic stump after distal pancreatectomy (DP) are common radiological findings in follow-up scans. No recommendations exist regarding the management of such findings. The aim was to characterise incidence, risk factors, clinical impact and therapy of FC.

Method: Data of 209 patients who underwent DP between 07/2009 and 06/2011 were prospectively collected and analysed, regarding follow-up CT or MRI scan findings of FC at the resection margin. FC was defined as a cyst-like lesion >1 cm in diameter.

Results: A follow-up with at least two cross-sectional images was available in 159/209 patients. In the first postoperative control, 68 patients showed an FC (43%). FC size was classified as <5 cm (n = 38 pat.), 5-10 cm (n = 24 pat.) and >10 cm (n = 6 pat.). 20 patients (30%) showed clinical symptoms. Six patients (9%) required specific treatment, all other FC showed spontaneous regression. No correlation with stump closure techniques or preceding postoperative pancreatic fistula was found (4/68 patients, 6%). Multivariate analysis revealed standard resections as the only significant factor for FC.

Conclusions: FCs at the resection margin after DP are frequent and harmless findings. Therapeutic interventions are required in only 9% of all FC patients.

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Figures

Figure 1
Figure 1
Study flow chart
Figure 2
Figure 2
Course of 58 FCs without therapy. Size in mm (left axis) at the different time points of follow-up (2–5 follow-up examinations)
Figure 3
Figure 3
Follow-up MRI scans (T2-weighted) showing FC (54 mm, white arrow) at the resection margin three months after DP (above). Complete resolution without FC-directed therapy after six months (below). Resection margin at the level of superior mesenteric vein (broke white arrow) and superior mesenteric artery (dotted white arrow)
See this image and copyright information in PMC

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