Incidence and outcomes of postoperative fluid collections after minimally invasive distal pancreatectomy without placement of surgical drain. A prospective observational cohort study

Abstract

Background/PurposeThere is uncertainty about the role of prophylactic intra‐abdominal drains after distal pancreatectomy. In the present study, we aimed to describe the long‐term outcomes of postoperative pancreatic collections in patients who underwent a minimally invasive distal pancreatectomy (MIDP) without surgical drain placement.MethodsFrom 2018 to 2022, consecutive patients who underwent a MIDP were recorded. Patients were followed at 90 days, 6 months, and in the long term. The use of interventional procedures and antibiotic therapy were documented, and the overall evolution of the collections was assessed.ResultsA total of 91 patients underwent MIDP; 11 were excluded; 80 were analyzed. Median age was 63 (51–73) years; 61.3% were women. Most lesions (71.3%) were malignant; 15 patients received neoadjuvant therapy. Procedures were laparoscopic (87.5%) or robotic (12.5%). Incidence of postoperative pancreatic collections was 33%; 10 patients were symptomatic. Interventional endoscopic (n = 3) or percutaneous (n = 3) procedures were required. At a follow‐up of 24 (17.5–33.1) months, 18 collections resolved completely, eight partially, and one increased.ConclusionsPatients who undergo MIDP without surgical drain placement develop well‐tolerated pancreatic collections. Although a minority may require endoscopic or percutaneous drainage, the majority can be managed conservatively and resolve spontaneously in the long term.