Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer Journal Article

  

Authors:	Kehoe, S. M.; Eisenhauer, E. L.; Abu-Rustum, N. R.; Sonoda, Y.; D'Angelica, M.; Jarnagin, W. R.; Barakat, R. R.; Chi, D. S.
Article Title:	Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer
Abstract:	Objective: To determine the incidence, management, and outcome of patients diagnosed with a pancreatic leak after a distal pancreatectomy during primary surgical cytoreduction for ovarian, peritoneal, or tubal cancer. Methods: We performed a retrospective chart review of all patients who had a distal pancreatectomy at the time of primary surgery. Charts were reviewed to identify those patients who developed a persistent left upper quadrant abdominal fluid collection with elevated amylase levels. Results: A total of 17 patients had a distal pancreatectomy; of these, 4 patients (24%) developed a postoperative pancreatic leak. In these patients, persistent leukocytosis prompted evaluation with a computed tomography scan, which subsequently revealed a fluid collection. The median time from surgery to drainage of this collection was 9 days (range, 8-66). The drain remained in situ for a median of 29 days (range, 22-82). The median amylase level of the fluid was 22,945 U/L (range, 763-47,250). The median length of hospital stay for those patients with a leak was 33 days (range, 25-44), which was longer than those without a leak. However, the median time from surgery to treatment with systemic chemotherapy was 31 days (range, 16-43), which was equivalent to those without a pancreatic leak. Conclusion: Twenty-four percent of patients who had undergone a distal pancreatectomy developed a pancreatic leak. This complication, which usually presents early in the postoperative period, can be managed conservatively with percutaneous drainage. Oral intake may be resumed, and total parenteral nutrition is not needed in the majority of cases. Systemic chemotherapy can be administered without significant delay. © 2008 Elsevier Inc. All rights reserved.
Keywords:	cancer chemotherapy; clinical article; retrospective studies; clinical feature; splenectomy; postoperative period; advanced cancer; ascites; systemic therapy; treatment duration; pancreas resection; outcome assessment; antineoplastic agent; cytoreductive surgery; ovarian neoplasms; computer assisted tomography; multiple cycle treatment; ovary cancer; peritoneum cancer; peritoneal neoplasms; incidence; medical record review; postoperative complication; patient care; length of stay; abdomen; conservative treatment; pancreatectomy; total parenteral nutrition; octreotide; uterine tube carcinoma; advanced ovarian cancer; fallopian tube neoplasms; amylase blood level; absence of side effects; leukocytosis; distal pancreatectomy; pancreatic leak; amylase; somatostatin derivative; abdominal drainage; pancreas disease; percutaneous drainage; amylases; drainage; pancreatic fistula
Journal Title:	Gynecologic Oncology
Volume:	112
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2009-03-01
Start Page:	496
End Page:	500
Language:	English
DOI:	10.1016/j.ygyno.2008.10.011
PUBMED:	19091388
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-60449085876&partnerID=40&md5=f1f721d4a0cd29657c492298a47f312a
Notes:	--- - "Cited By (since 1996): 3" - "Export Date: 30 November 2010" - "CODEN: GYNOA" - "Source: Scopus"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/790