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The treatment indication and optimal management of fluid collection after laparoscopic distal pancreatectomy

  • Ki Byung Song
  • Jaewoo Kwon
  • Young-Joo Lee
  • Dae Wook Hwang
  • Jae Hoon Lee
  • Sang Hyun Shin
  • Myung-Hwan Kim
  • Sung Koo Lee
  • Dong-Wan Seo
  • Sang Soo Lee
  • Do Hyun Park
  • Tae Jun Song
  • Guisuk Park
  • Yejong Park
  • Seung Jae Lee
  • Song Cheol Kim
Article

Abstract

Background

Recently, laparoscopic distal pancreatectomy (LDP) has become the standard procedure for resection of left-sided pancreatic tumors. Fluid collection (FC) at the resection margin of the pancreatic stump after LDP is a frequent radiological finding. However, there have been few treatment guidelines and the optimal management for this clinical finding is unclear. The aim of present study is to define the incidence of FC and suggest the optimal management for FC after LDP.

Methods

A total of 1227 patients who underwent LDP between March 2005 and December 2015 were collected. FC was considered present when the longest diameter of the lesion on CT scan was > 3 cm.

Results

A follow-up with at least two CT image was available for 1102 patients. Of these, 689 (62.5%) patients showed initial fluid collection (IFC) at the pancreas resection site in immediate postoperative CT. IFC (+) group had higher proportion of men, BMI, and higher rate of concomitant splenectomy than IFC (−) group. Among patients with FC after LDP, the treatment group had more frequent leukocytosis and accompanying symptoms than the observation group. Seventy-seven patients underwent therapeutic interventions for FC after LDP. Among them, 55 (71.4%) patients underwent endoscopic ultrasonography-guided gastrocystostomy (EUS-GC). EUS-GC group had a higher success rate (85.6 vs. 63.6%, p < 0.033) and shorter hospital stay after the intervention (5.2 vs. 13.3 days, p < 0.001) than those who underwent other procedures.

Conclusions

High BMI, male, and concomitant splenectomy contribute to the occurrence of FC after LDP. In most cases, FC after LDP resolved spontaneously over time with observation. The patients with symptomatic FC ultimately required treatment. EUS-GC is the optimal intervention therapy for FC after LDP.

Keywords

Laparoscopic distal pancreatectomy Fluid collection Endoscopic ultrasonography Symptom Complication 

Notes

Acknowledgements

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Grant Number: HI14C2640).

Compliance with ethical standards

Disclosures

Ki Byung Song, Jaewoo Kwon, Young-Joo Lee, Dae Wook Hwang, Jae Hoon Lee, Sang Hyun Shin, Myung-Hwan Kim, Sung Koo Lee, Dong-Wan Seo, Sang Soo Lee, Do Hyun Park, Tae Jun Song, Guisuk Park, Yejong Park, Seung Jae Lee, and Song Cheol Kim have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ki Byung Song
    • 1
  • Jaewoo Kwon
    • 1
  • Young-Joo Lee
    • 1
  • Dae Wook Hwang
    • 1
  • Jae Hoon Lee
    • 1
  • Sang Hyun Shin
    • 1
  • Myung-Hwan Kim
    • 2
  • Sung Koo Lee
    • 2
  • Dong-Wan Seo
    • 2
  • Sang Soo Lee
    • 2
  • Do Hyun Park
    • 2
  • Tae Jun Song
    • 2
  • Guisuk Park
    • 1
  • Yejong Park
    • 1
  • Seung Jae Lee
    • 1
  • Song Cheol Kim
    • 1
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulRepublic of Korea
  2. 2.Division of Gastroenterology, Department of Internal MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea

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