Objective
To determine the incidence, associated factors, natural history, and interventions for FCs

Cannaday, CRNP, Shawnna

Krampitz, MD, PhD, Geoffrey

Lavu, MD, Harish

Morano, MS, Michael

Nauheim, MS, David

Papai, MS, Emily

Tham, MD, Elwin

Wagner, MS, Nicole

Yeo, MD, Charles J.

Yeo, PhD, Theresa P.

English

Jefferson Digital Commons

BackgroundPeri-pancreatic fluid collections (FCs) following distal pancreatectomyand splenectomy (DPS) are often encountered though their preciseincidence and indications for intervention are not well defined.1ObjectiveTo determine the incidence, associated factors, natural history, andinterventions for FCs.MethodsConclusion§ In this study, FCs following DPS were a frequent finding onpostoperative cross-sectional imaging with an incidence of 45%.§ FCs that present with vague abdominal symptoms, leukocytosis, orfevers are often diagnosed as POPFs, intra-abdominal abscesses,pseudocysts and may require intervention.§ Clinically non-significant AFCs after DPS may spontaneouslyresolve (62%) without requiring intervention.ResultsAsymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?Elwin Tham MD1, Emily Papai MS2, David Nauheim MS2, Michael Morano MS2, Nicole Wagner MS2, Shawnna Cannaday CNRP1, Theresa P Yeo PhD1, Geoffrey W Krampitz MD PhD1, Charles J Yeo MD1, Harish Lavu MD11. Thomas Jefferson University Hospital, Department of Surgery2. Sidney Kimmel Medical College, Jefferson UniversityTable 1: Patient CharacteristicsAll patients FC No FC p valueNumber of Patients 185 83 (45%) 102 (55%)Median Age (IQR) 65 (56-72) 65 (57-71) 65 (56-72)Sex p=0.10Male 108 (58%) 43 (52%) 65 (64%)Female 77 (42%) 40 (48%) 37 (36%)Diagnosis p=0.19Benign 97 (52%) 39 (47%) 58 (57%)PNET 30 (16%) 14 (17%) 16 (16%)IPMN 25 (14%) 7 (8%) 18 (18%)Other 19 (10%) 8 (10%) 11 (11%)SCN 7 (4%) 7 (8%) 0 (0%)Pancreatitis 6 (3%) 2 (2%) 4 (4%)MCN 5 (3%) 1 (1%) 4 (4%)Malignant 88 (48%) 44 (53%) 44 (43%)PDAC 74 (40%) 35 (42%) 39 (38%)Other 14 (8%) 9 (11%) 5 (5%)Closure method p=0.40Suture 144 (78%) 67 (81%) 77 (75.5%)Staple 41 (22%) 16 (19%) 25 (24.5%)Gland Texture p=0.13Soft 149 (80.5%) 71 (85.5%) 78 (76.5%)Firm 36 (19.5%) 12 (14.5%) 24 (23.5%)Median Blood loss (cc)200 200 200Morbidity 45 (24%) 22 (27%) 23 (23%) p=0.53POPF 24 (13%) 15 (18%) 9 (9%) p=0.06Median LOS (days) 5 5 5Discharged with Drainsp=0.31Yes 30 (16%) 16 (19%) 14 (14%)30 day readmission p=0.007Yes 49 (27%) 30 (36%) 19 (19%)References1. Tjaden C, Hinz U, Hassenpflug M, et al. Fluid collection after distal pancreatectomy: a frequent finding. HPB (Oxford). 2016;18(1):35-40.We performed a single-institution retrospective review of patients withidentifiable FCs on postoperative cross-sectional imaging followingDPS between 2013 and 2018 (Figure 1). We defined FCs as cyst-likestructures >1cm in diameter adjacent to the pancreatic stump. Weexamined diagnoses, operative notes, postoperative course, imagingfindings, and interventions.Asymptomatic Fluid Collections without intervention*PNET – Pancreatic neuroendocrine tumor; IPMN – Intraductal Papillary Mucosal Neoplasm; SCN – Serous Cystic Neoplasm; MCN – Mucinous Cystic Neoplasm; PDAC – Pancreatic Ductal Adenocarcinoma; POPF – Postoperative Pancreatic Fistula; LOS – Length of stayWe identified a total of 185 patients who had postoperative imagingfollowing DPS, 83 (45%) of whom had FCs. Of these, 44 (53%) weresymptomatic (SFCs). Presenting symptoms included: abdominal pain,nausea, fevers, chest pain, shortness of breath. 32 (73%) patients withSFCs required intervention via IR drainage (n=26), endoscopicdrainage (n=5), and medical management (n=1) respectively. Of the39 (47%) patients with AFCs, 2 (5%) patients required intervention viaendoscopic drainage. No studied variables were associated with anincreased incidence of postoperative FCs after DPS. Patients with FCsafter DPS were more likely to be readmitted within 30 days aftersurgery (univariate OR = 2.47, p=0.007).AFCS without intervention were examined to identify their naturalhistory (Figure 2). Of the 37 patients with AFCs who did not undergointervention, only 21 had 2 or more postoperative imaging studies. Ofthese patients, AFCs in 13 patients (62%) resolved spontaneously onfollow-up imaging. The median time to resolution was 13.2 months.02468101214161820220 5 10 15 20 25 30 35 40 45 50 55Size of FC (cm)Time after surgery (months)Figure 2: Natural Progression of 21 AFCs without interventionDPS 2013 – 2018 (n=238)Excluded (n=53)Postoperative Cross-sectional imaging (n=185)No FC (n= 102) FC (n=83)AFC (n=39)Intervention (n=2)Endoscopic drainage (n=2)No Intervention (n=37)>2 Postop Imaging (n=21)Spontaneous Regression (n=13)Persistent AFC (n=8)<2 Postop imaging (n=16)SFC (n=44)Intervention (n=32)IR drainage (n=26)Endoscopic drainage (n=5)Medical Management (n=1)No Intervention (n=12)*AFC – Asymptomatic fluid collections; SFC – Symptomatic fluid collections; IR – interventional radiologyFigure 1: Study Flow Chart

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1048&context=patientsafetyconference

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?

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