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A drainage strategy for postoperative pancreatic fistula after left-sided pancreatectomy based on the wall status of collected fluid

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Abstract

Purpose

Postoperative pancreatic fistula (POPF) after pancreatectomy is one of the severe postoperative adverse events. We aimed to clarify the outcomes of a strategy for POPF after left-sided pancreatectomy with one-step endoscopic ultrasonography-guided drainage (EUSD) and percutaneous drainage (PCD) based on the wall status of collected fluid.

Methods

From January 2012 to September 2017, 90 of 336 patients developed grade B/C POPF and were retrospectively analyzed. Primary outcome measures were the technical and clinical success and resolution rates. Secondary outcome measures were time from surgery to intervention, and time from intervention to discharge/resolution or stent/tube removal and adverse events.

Results

Seventeen patients underwent EUSD and 73 patients underwent PCD for POPF. The technical success rates were 100% in both the EUSD and PCD groups. The clinical success and resolution rates in the EUSD group were 100%, while those in the PCD group were 98.6%. The time from surgery to intervention was significantly longer in the EUSD group than in the PCD group (20 vs. 11 days, p < 0.001). The time from intervention to discharge/resolution was significantly shorter in the EUSD group than in the PCD group (11 vs. 22 days, p < 0.001/10 vs. 20 days, p < 0.001). The time from intervention to stent/tube removal was significantly shorter in the PCD group than in the EUSD group (20.5 vs. 873 days, p < 0.001). Adverse event rates were similar in the two groups (11.8% vs. 5.5%).

Conclusion

A drainage strategy for POPF based on the wall status of collected fluid is appropriate.

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Acknowledgments

We deeply appreciate the support provided by Dr. Shin Kato, Dr. Koji Hirata, Dr. Hajime Hirata, Dr. Ryo Sugiura, Dr. Ryutaro Furukawa, Dr. Yunosuke Takishin, Dr. Naoya Sakamoto, Dr. Takahiro Tsuchikawa, Dr. Kimitaka Tanaka, Dr. Yoshitsugu Nakanishi, and Dr. Tomohide Nakayama from Hokkaido University Hospital; Dr. Kazuma Ishikawa, Dr. Yuki Ikeda, Dr. Yoshiharu Masaki, Dr. Ayako Ito, and Dr. Minoru Nagayama from Sapporo Medical University; Dr. Kei Yane, Dr. Toshifumi Kin, Dr. Kazunari Tanaka, Dr. Koki Chikugo, Dr. Shunsuke Honda, Dr. Haruka Toyonaga, Dr. Hidetaro Ueki, Dr. Yoshiyasu Anbo, Dr. Minoru Takada, and Dr. Kentaro Kato from Teine Keijinkai Hospital.

Hokkaido Pancreatic Cancer Study Group: HOPS—Masaki Kuwatani; Masafumi Imamura; Tsuyoshi Hayashi; Makoto Yoshida; Yasutoshi Kimura; Toshimichi Asano; Toru Nakamura; Masayo Motoya; Makoto Yoshida; Takehiro Noji; Keisuke Okamura; Kuniyuki Takahashi; Akio Katanuma; Satoshi Hirano.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan

    Masaki Kuwatani

  2. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, 060-8556, Japan

    Masafumi Imamura & Yasutoshi Kimura

  3. Center for Gastroenterology, Teine-Keijinkai Hospital, Maeda 1-jo 12-chome 1-40, Teine-ku, Sapporo, 006-0811, Japan

    Tsuyoshi Hayashi, Kuniyuki Takahashi & Akio Katanuma

  4. Department of Surgery, Kin-ikyo Chuo Hospital, Higashi-naebo 5-jo 1-chome 9-1, Higashi-ku, Sapporo, 007-8505, Japan

    Makoto Yoshida

  5. Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan

    Toshimichi Asano, Toru Nakamura, Takehiro Noji, Keisuke Okamura & Satoshi Hirano

  6. Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, 060-8556, Japan

    Masayo Motoya

  7. Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, 060-8556, Japan

    Makoto Yoshida

Authors
  1. Masaki Kuwatani
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  2. Masafumi Imamura
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Hokkaido Pancreatic Cancer Study Group: HOPS

Contributions

M. Kuwatani, T. Hayashi, M. Yoshida, M. Motoya, T. Nakamura, Y. Kimura, T. Noji, K. Okamura, and K. Takahashi contributed to the study concept, design, and definition of intellectual content. M. Kuwatani contributed to the literature search, data analysis, and statistical analysis. M. Kuwatani, M. Imamura, T. Hayashi, M. Yoshida, and T. Asano contributed to data acquisition. M. Kuwatani, T. Hayashi, and Y. Kimura contributed to manuscript preparation and manuscript editing. A. Katanuma and S. Hirano contributed to manuscript review.

Corresponding author

Correspondence to Masaki Kuwatani.

Ethics declarations

Enrollment into this study was performed with informed consents of the patients or their families. In addition, this study was performed in accordance with the Declaration of Helsinki.

This manuscript has been read and approved by all the authors, and the requirements for authorship as stated in the document of instructions of the authors have been met.

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The authors declare that they have no conflicts of interest.

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Kuwatani, M., Imamura, M., Hayashi, T. et al. A drainage strategy for postoperative pancreatic fistula after left-sided pancreatectomy based on the wall status of collected fluid. Langenbecks Arch Surg 406, 743–751 (2021). https://doi.org/10.1007/s00423-020-02067-8

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  • DOI: https://doi.org/10.1007/s00423-020-02067-8

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