Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation

• Published in: British journal of surgery 2003-02, Vol.90 (2), p.190-196
• Main Authors: Bilimoria, M. M., Cormier, J. N., Mun, Y., Lee, J. E., Evans, D. B., Pisters, P. W. T.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Renal Cell - surgery; Child; Child, Preschool; Female; Humans; Ligation; Liver, biliary tract, pancreas, portal circulation, spleen; Lymph; Male; Medical sciences; Middle Aged; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatic Ducts - surgery; Pancreatic Neoplasms - surgery; Postoperative Complications - prevention & control; Prospective Studies; Retroperitoneal Neoplasms - surgery; Retrospective Studies; Sarcoma - surgery; Stomach Neoplasms - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4032

Background: Although much is known about the long‐term outcome of patients undergoing left (distal) pancreatectomy for malignancy, comparatively little is known about the optimal management strategy for the residual transected pancreatic parenchyma and the divided pancreatic duct. Clinicopathological and operative factors that may contribute to postoperative pancreatic leak were evaluated. Methods: A retrospective review of the medical records of 126 patients who underwent left pancreatectomy between June 1990 and December 1999 at the University of Texas M. D. Anderson Cancer Center was performed. Results: Indications for left pancreatectomy included pancreatic neoplasms (n = 42; 33·3 per cent), en bloc resection for management of retroperitoneal sarcoma (n = 21; 16·7 per cent), gastric adenocarcinoma (n = 14; 11·1 per cent), renal cell carcinoma (n = 11; 8·7 per cent) and other tumours or benign conditions (n = 38; 30·2 per cent). Pancreatic parenchymal closure was accomplished by a hand‐sewn technique, mechanical stapling, or a combination of the two in 83, 20 and 15 patients respectively. No form of parenchymal closure was used in eight patients. Identification of the pancreatic duct and suture ligation was performed in 73 patients (57·9 per cent). Twenty‐five patients (19·8 per cent) developed a pancreatic leak. For subgroups having duct ligation or no duct ligation, pancreatic leak rates were 9·6 per cent (seven of 73 patients) and 34·0 per cent (18 of 53 patients) respectively (P < 0·001). Multivariate analysis including clinicopathological and operative factors indicated that failure to ligate the pancreatic duct was the only feature associated with an increased risk for pancreatic leak (odds ratio 5·0 (95 per cent confidence interval 2·0 to 10·0); P = 0·001). Conclusion: Pancreatic leak remains a common complication after left pancreatectomy. The incidence of leak is reduced significantly when the pancreatic duct is identified and directly ligated during left pancreatectomy. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Proper ligation of the duct is important