Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 21:8:804675.
doi: 10.3389/fsurg.2021.804675. eCollection 2021.

Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

Antonio Giuliani  1   2 , Pasquale Avella  3 , Anna Lucia Segreto  4 , Maria Lucia Izzo  1 , Antonio Buondonno  3 , Mariagrazia Coluzzi  1 , Micaela Cappuccio  3 , Maria Chiara Brunese  3 , Roberto Vaschetti  3 , Andrea Scacchi  3 , Germano Guerra  3 , Bruno Amato  5 , Fulvio Calise  2   6 , Aldo Rocca  3   6
Affiliations

Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

Antonio Giuliani et al. Front Surg. .

Abstract

Background: Surgical resection is the only possible choice of treatment in several pancreatic disorders that included periampullar neoplasms. The development of a postoperative pancreatic fistula (POPF) is the main complication. Despite three different surgical strategies that have been proposed-pancreatojejunostomy (PJ), pancreatogastrostomy (PG), and pancreatic duct occlusion (DO)-none of them has been clearly validated to be superior. The aim of this study was to analyse the postoperative outcomes after DO. Methods: We retrospectively reviewed 56 consecutive patients who underwent Whipple's procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit. After pancreatic resection in open surgery, we performed DO of the Wirsung duct with Cyanoacrylate glue independently from the stump characteristics. The mean follow-up was 24.5 months. Results: In total, 29 (60.4%) were men and 19 were (39.6%) women with a mean age of 62.79 (SD ± 10.02) years. Surgical indications were in 95% of cases malignant diseases. The incidence of POPF after DO was 31 (64.5%): 10 (20.8%) patients had a Grade A fistula, 18 (37.5%) Grade B fistula, and 3 (6.2%) Grade C fistula. No statistical differences were demonstrated in the development of POPF according to pancreatic duct diameter groups (p = 0.2145). Nevertheless, the POPF rate was significantly higher in the soft pancreatic group (p = 0.0164). The mean operative time was 358.12 min (SD ± 77.03, range: 221-480 min). Hospital stay was significantly longer in patients who developed POPF (p < 0.001). According to the Clavien-Dindo (CD) classification, seven of 48 (14.58%) patients were classified as CD III-IV. At the last follow-up, 27 of the 31 (87%) patients were alive. Conclusions: Duct occlusion could be proposed as a safe alternative to pancreatic anastomosis especially in low-/medium-volume centers in selected cases at higher risk of clinically relevant POPF.

Keywords: COVID-19 pandemic; POPF; duct occlusion; low-volume center; pancreatic cancer; pancreatic stump; pancreatic surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The study flow-chart according to the STROBE statements. STROBE, the Strengthening the Reporting of Observational Studies in Epidemiology.
Figure 2
Figure 2
Cyanoacrylate glue injection in Wirsung duct to obtain pancreatic duct occlusion.
Figure 3
Figure 3
Distribution of patients after pancreatic duct occlusion according to POPF grade. POPF, postoperative pancreatic fistula.
Figure 4
Figure 4
Preoperative, postoperative, and 7-day postoperative hematic amylase trends in patients who underwent pancreatic duct occlusion with and without fistula.
See this image and copyright information in PMC

References

    1. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. (2004) 91:586–94. 10.1002/bjs.4484 - DOI - PubMed
    1. Seiler CA, Wagner M, Bachmann T, Redaelli CA, Schmied B, Uhl W, et al. . Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg. (2005) 92:547–56. 10.1002/bjs.4881 - DOI - PubMed
    1. D'Souza MA, Shrikhande SV. Pancreatic resectional surgery: an evidence-based perspective. J Cancer Res Ther. (2008) 4:77–83. 10.4103/0973-1482.42253 - DOI - PubMed
    1. Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, et al. . Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol. (2010) 102:82–6. 10.1002/jso.21541 - DOI - PubMed
    1. Marte G, Scuderi V, Rocca A, Surfaro G, Migliaccio C, Ceriello A. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach. Updates Surg. (2013) 65:115–9. 10.1007/s13304-013-0197-0 - DOI - PubMed

LinkOut - more resources