Thirty-day prevalence and clinical impact of fluid collections at the resection margin after distal pancreatectomy: Follow-up of a multicentric randomized controlled trial

Matteo De Pastena; Elisa Bannone; Martina Fontana; Salvatore Paiella; Alessandro Esposito; Luca Casetti; Luca Landoni; Massimiliano Tuveri; Antonio Pea; Fabio Casciani; Giulia Zamboni; Isabella Frigerio; Giovanni Marchegiani; Giovanni Butturini; Giuseppe Malleo; Roberto Salvia

doi:10.1016/j.surg.2024.03.026

Thirty-day prevalence and clinical impact of fluid collections at the resection margin after distal pancreatectomy: Follow-up of a multicentric randomized controlled trial

Surgery. 2024 May 10:S0039-6060(24)00191-0. doi: 10.1016/j.surg.2024.03.026. Online ahead of print.

Authors

Matteo De Pastena¹, Elisa Bannone², Martina Fontana³, Salvatore Paiella³, Alessandro Esposito³, Luca Casetti³, Luca Landoni³, Massimiliano Tuveri³, Antonio Pea⁴, Fabio Casciani³, Giulia Zamboni⁵, Isabella Frigerio⁶, Giovanni Marchegiani⁷, Giovanni Butturini⁶, Giuseppe Malleo⁸, Roberto Salvia⁹

Affiliations

¹ Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. Electronic address: https://twitter.com/MatteoDePastena.
² Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. Electronic address: https://twitter.com/BannoneElisa.
³ Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
⁴ Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. Electronic address: https://twitter.com/Totuccio1983.
⁵ Section of Radiology University of Verona Hospital Trust, Verona, Italy.
⁶ Unit of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy.
⁷ Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy. Electronic address: https://twitter.com/Gio_Marchegiani.
⁸ Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. Electronic address: https://twitter.com/gimalleo.
⁹ Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. Electronic address: roberto.salvia@univr.it.

PMID: 38729888
DOI: 10.1016/j.surg.2024.03.026

Abstract

Background: Postoperative fluid collections at the resection margin of the pancreatic stump are frequent after distal pancreatectomy, yet their clinical impact is unclear. The aim of this study was to assess the 30-day prevalence of postoperative fluid collections after distal pancreatectomy and the factors associated with a clinically relevant condition.

Methods: Patients enrolled in a randomized controlled trial of parenchymal transection with either reinforced, triple-row staple, or ultrasonic dissector underwent routine magnetic resonance 30 days postoperatively. Postoperative fluid collection was defined as a cyst-like lesion of at least 1 cm at the pancreatic resection margin. Postoperative fluid collections requiring any therapy were defined as clinically relevant.

Results: A total of 133 patients were analyzed; 69 were in the triple-row staple transection arm, and 64 were in the ultrasonic dissector transection arm. The overall 30-day prevalence of postoperative fluid collections was 68% (n = 90), without any significant difference between the two trial arms. Postoperative serum hyperamylasemia was more frequent in patients with postoperative fluid collections than those without (31% vs 7%, P = .001). Among the postoperative fluid collection population, an early postoperative pancreatic fistula (odds ratio 14.9, P = .002), post pancreatectomy acute pancreatitis (odds ratio 12.7, P = .036), and postoperative fluid collection size larger than 50 mm (odds ratio 6.6, P = .046) were independently associated with a clinically relevant postoperative fluid collection.

Conclusion: Postoperative fluid collections at the resection margin are common after distal pancreatectomy and can be predicted by early assessment of postoperative serum hyperamylasemia. A preceding pancreatectomy acute pancreatitis and/or postoperative pancreatic fistula and large collections (>50 mm) were associated with a clinically relevant postoperative fluid collection, representing targets for closer follow-up or earlier therapeutic interventions.