Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Table 1 Main parameters for postoperative pancreatic fistula grading[5]

Grade	A	B	C
Clinical conditions	Well	Often well	Ill appearing/bad
Specific treatment1	No	Yes/No	Yes
US/CT	Negative	Negative/Positive	Positive
Persistent drainage (after 3 wk)	No	Usually yes	Yes
Reoperation	No	No	Yes
Death related to fistula	No	No	Possibly yes
Signs of infection	No	Yes	Yes
Sepsis	No	No	Yes
Readmission	No	Yes/No	Yes/No

¹Partial (peripheral) or total parenteral nutrition, antibiotics, enteral nutrition, somatostatin analogue and/or minimal invasive drainage.

Table 2 Patients’ demographics, indications for surgery, operative and technical factors

	No. of patients (%)
Sex
Male	30 (47)
Female	34 (53)
Indications for surgery
Pancreatic
Cystadenoma	19 (30)
Adenocarcinoma	11 (17)
Neuroendocrine tumour	3 (5)
Cystadenocarcinoma	3 (5)
Chronic pancreatitis	1 (1.5)
Lymphangioma	1 (1.5)
Non-pancreatic
Gastric adenocarcinoma	16 (25)
Retroperitoneal sarcoma	4 (6)
Colonic adenocarcinoma	2 (3)
Renal carcinoma	2 (3)
Adrenal grand carcinoma	1 (1.5)
Gastrointestinal stromal tumour	1 (1.5)
Operations
DP + splenectomy	13 (20)
Spleen preserving DP	8 (13)
DP + splenectomy + additional procedure	43 (67)
Additional procedures
Gastrectomy	26 (46)
Colon resection	12 (21)
Adrenalectomy	10 (17)
Small intestine resection	5 (9)
Nephrectomy	4 (7)
Closure of pancreatic stump
Stapler	29 (45)
Suture	35 (55)

Table 3 Postoperative results

	No. of patients (%)
Death	1 (1.5)
Reoperation	2 (3)
Complications
No	40 (63)
Yes	24 (37)
Pancreatic fistula	14 (22)
Grade A	4 (28.6)
Grade B	9 (64.3)
Grade C	1 (7.1)
Intra-abdominal hemorrhage	2 (3)
Intra-abdominal abscess	3 (5)
Pulmonary	5 (8)

Table 4 Incidence of pancreatic fistula after distal pancreatectomy according to examined risk factors

		Fistula
	Patients(n = 64)	No.(n = 50)	Yes(n = 14)	Pvalue
Age (yr)				NS
< 70	23 (36)	17 (34)	6 (43)
> 70	41 (64)	33 (66)	8 (57)
Sex				NS
Male	30 (47)	23 (46)	7 (50)
Female	34 (53)	27 (53)	7 (50)
Pancreatic stump closure				NS
Stapler	29 (45)	22 (44)	7 (50)
Suture	35 (55)	28 (56)	7 (50)
Pathology				0.04
Pancreatic disease	38 (59)	27 (54)	11 (79)
Non-pancreatic malignancy	26 (41)	23 (46)	3 (21)
Octreotide therapy				0.01
Yes	34 (53)	30 (60)	4 (28)
No	30 (47)	20 (40)	10 (72)
Texture of pancreatic parenchyma				0.006
Soft	27 (42)	15 (30)	12 (86)
Fibrotic	37 (58)	35 (70)	2 (14)
Concomitant splenectomy				0.002
Yes	56 (87)	46 (92)	10 (71)
No	8 (13)	4 (8)	4 (29)
Procedures				NS
Pancreatic resection only	21 (33)	14 (28)	7 (50)
Additional procedures	43 (67)	36 (72)	7 (50)

NS: No significant. Values in parentheses are percentages.