Christin Tjaden1, Ulf Hinz1, Matthias Hassenpflug1, Franziska Fritz2, Stefan Fritz1, Lars Grenacher3, Markus W Büchler1, Thilo Hackert4. 1. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. 2. Department of Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. 3. Diagnostik Munich, Diagnostic Imaging Center, Augustenstr. 115, 80798 Munich, Germany. 4. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: thilo.hackert@med.uni-heidelberg.de.
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.
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.
Authors: Sandeep S Vijan; Kamran A Ahmed; William S Harmsen; Florencia G Que; Kaye M Reid-Lombardo; David M Nagorney; John H Donohue; Michael B Farnell; Michael L Kendrick Journal: Arch Surg Date: 2010-07
Authors: Claudio Bassi; Christos Dervenis; Giovanni Butturini; Abe Fingerhut; Charles Yeo; Jakob Izbicki; John Neoptolemos; Michael Sarr; William Traverso; Marcus Buchler Journal: Surgery Date: 2005-07 Impact factor: 3.982
Authors: Moritz N Wente; Claudio Bassi; Christos Dervenis; Abe Fingerhut; Dirk J Gouma; Jakob R Izbicki; John P Neoptolemos; Robert T Padbury; Michael G Sarr; L William Traverso; Charles J Yeo; Markus W Büchler Journal: Surgery Date: 2007-11 Impact factor: 3.982
Authors: Niels A van der Gaag; Andries C Verhaar; Elizabeth B Haverkort; Olivier R C Busch; Thomas M van Gulik; Dirk J Gouma Journal: J Am Coll Surg Date: 2008-08-23 Impact factor: 6.113
Authors: Cristina R Ferrone; Andrew L Warshaw; David W Rattner; David Berger; Hui Zheng; Bhupendra Rawal; Ruben Rodriguez; Sarah P Thayer; Carlos Fernandez-del Castillo Journal: J Gastrointest Surg Date: 2008-08-13 Impact factor: 3.452
Authors: Brian K P Goh; Yu-Meng Tan; Yaw-Fui Alexander Chung; Peng-Chung Cheow; Hock-Soo Ong; Weng-Hoong Chan; Pierce K H Chow; Khee-Chee Soo; Wai-Keong Wong; London L P J Ooi Journal: Arch Surg Date: 2008-10
Authors: Jörg Kleeff; Markus K Diener; Kaspar Z'graggen; Ulf Hinz; Markus Wagner; Jeannine Bachmann; Jörg Zehetner; Michael W Müller; Helmut Friess; Markus W Büchler Journal: Ann Surg Date: 2007-04 Impact factor: 12.969
Authors: Emily Z Keung; Elliot A Asare; Yi-Ju Chiang; Laura R Prakash; Nikita Rajkot; Keila E Torres; Kelly K Hunt; Barry W Feig; Janice N Cormier; Christina L Roland; Matthew H G Katz; Jeffrey E Lee; Ching-Wei D Tzeng Journal: Am J Surg Date: 2019-11-30 Impact factor: 2.565
Authors: Javier A Cienfuegos; Joseba Salguero; Jorge M Núñez-Córdoba; Miguel Ruiz-Canela; Alberto Benito; Sira Ocaña; Gabriel Zozaya; Pablo Martí-Cruchaga; Fernando Pardo; José Luis Hernández-Lizoáin; Fernando Rotellar Journal: Surg Endosc Date: 2017-01-26 Impact factor: 4.584