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

Siobhan M. Kehoe, Eric L. Eisenhauer, Nadeem R. Abu-Rustum, Yukio Sonoda, Michael D'Angelica, William R. Jarnagin, Richard R. Barakat, Dennis S. Chi

Research output: Contribution to journalArticle

34 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)496-500
Number of pages5
JournalGynecologic Oncology
Volume112
Issue number3
DOIs
StatePublished - Mar 2009

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Fallopian Tube Neoplasms
Pancreatectomy
Splenectomy
Incidence
Amylases
Drainage
Length of Stay
Drug Therapy
Total Parenteral Nutrition
Leukocytosis
Postoperative Period
Tomography

Keywords

  • Advanced ovarian cancer
  • Distal pancreatectomy
  • Pancreatic leak

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer. / Kehoe, Siobhan M.; Eisenhauer, Eric L.; Abu-Rustum, Nadeem R.; Sonoda, Yukio; D'Angelica, Michael; Jarnagin, William R.; Barakat, Richard R.; Chi, Dennis S.

In: Gynecologic Oncology, Vol. 112, No. 3, 03.2009, p. 496-500.

Research output: Contribution to journalArticle

Kehoe, Siobhan M. ; Eisenhauer, Eric L. ; Abu-Rustum, Nadeem R. ; Sonoda, Yukio ; D'Angelica, Michael ; Jarnagin, William R. ; Barakat, Richard R. ; Chi, Dennis S. / Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer. In: Gynecologic Oncology. 2009 ; Vol. 112, No. 3. pp. 496-500.
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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.",
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AU - Eisenhauer, Eric L.

AU - Abu-Rustum, Nadeem R.

AU - Sonoda, Yukio

AU - D'Angelica, Michael

AU - Jarnagin, William R.

AU - Barakat, Richard R.

AU - Chi, Dennis S.

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AB - 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.

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