Stump Ischemia Is a Possible Risk Factor for Late-Onset Pancreatic Fistula After Distal Pancreatectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Radiology

Background:

• Late-onset pancreatic fistula (LOPF) is a complication following distal pancreatectomy (DP).
• Predictive markers for LOPF after stapled DP are crucial for patient management.
• Pancreatic stump ischemia (PSI) is a potential radiologic indicator.

Purpose of the Study:

• To assess the clinical significance of PSI in predicting LOPF after stapled DP.
• To establish radiologic criteria for identifying patients at risk of LOPF.

Main Methods:

• Retrospective analysis of 165 patients undergoing stapled DP.
• Definition of PSI as non-enhancing pancreatic tissue on postoperative contrast-enhanced CT.
• Diagnosis of LOPF based on clinical criteria requiring intervention after drain removal.

Main Results:

• LOPF occurred in 11.5% of patients.
• PSI was significantly more prevalent in patients who developed LOPF (47.4% vs. 21.2%).
• A PSI width of ≥1.9mm on CT was the optimal threshold for predicting LOPF, with an incidence of 26.5% in affected patients.

Conclusions:

• PSI is a significant radiologic predictor of LOPF following stapled DP.
• Early postoperative CT detection of an ischemic band ≥2mm warrants conservative drain management and close monitoring.
• LOPF did not develop beyond 90 days post-surgery, even with PSI.