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Langenbeck's Archives of Surgery

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01-05-2020 | Computed Tomography | Original Article

The location of perianastomotic fluid collection predicts postoperative complications after pancreaticoduodenectomy

Authors: Hiromitsu Maehira, Hiroya Iida, Takashi Matsunaga, Daiki Yasukawa, Haruki Mori, Toru Miyake, Masaji Tani

Published in: Langenbeck's Archives of Surgery | Issue 3/2020

Abstract

Purpose

Perianastomotic fluid collection (PFC) is one of the postoperative complications of pancreaticoduodenectomy (PD). However, no studies have investigated the clinical significance of PFC location and volume during the early postoperative period. This study aimed to assess the association between PFC during the early postoperative period and postoperative complications.

Methods

Medical records of 148 patients who had undergone PD and computed tomography (CT) on postoperative day 4 were retrospectively reviewed. The location—superior, inferior, ventral, dorsal, or splenic hilum—and PFC index, which is the estimated volume of fluid collection, were determined using CT. The associations between postoperative complication and the presence of PFC, and PFC index according to the location, were assessed.

Results

The PFC group included 102 patients (69%). Postoperative pancreatic fistula (POPF) and organ/space surgical site infection (SSI) were more frequent in the PFC group (42% vs 9%, p < 0.001 and 29% vs 11%, p = 0.020, respectively). Additionally, the PFC index was larger in patients who developed POPF, organ/space SSI, or pseudoaneurysm (81 cm³ vs 19 cm³, p < 0.001; 75 cm³ vs 30 cm³, p = 0.001; and 185 cm³ vs 31 cm³, p < 0.001, respectively). Furthermore, superior and ventral PFCs were associated with pseudoaneurysm (11% vs 0%, p = 0.006 and 14% vs 1%, p = 0.002, respectively), whereas inferior and dorsal PFCs were associated with deep incisional SSI (9% vs 0%, p = 0.027 and 8% vs 1%, p = 0.034, respectively).

Conclusion

The PFC location during the early postoperative period is associated with postoperative complications. Our findings may help determine the optimal location of prophylactic drains.

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Title: The location of perianastomotic fluid collection predicts postoperative complications after pancreaticoduodenectomy
Authors: Hiromitsu Maehira
Hiroya Iida
Takashi Matsunaga
Daiki Yasukawa
Haruki Mori
Toru Miyake
Masaji Tani
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Pancreaticojejunostomy
Computed Tomography
Published in: Langenbeck's Archives of Surgery / Issue 3/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01880-5

At a glance: The STEP trials

Springer Medicine

The location of perianastomotic fluid collection predicts postoperative complications after pancreaticoduodenectomy

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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