Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience

Sozzi, Giulio; Petrillo, Marco; Berretta, Roberto; Paci, Giuseppe; Musicò, Giulia; Donna, Mariano Catello Di; Vargiu, Virginia; Bernardini, Federica; Lago, Víctor; Domingo, Santiago; Fagotti, Anna; Scambia, Giovanni; Chiàntera, Vito

doi:10.1007/s00404-020-05684-2

Cited by 8 publications

(8 citation statements)

References 32 publications

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“…Currently, the risk factors and predictors of CR-POPF after cytoreductive surgery for advanced ovarian cancer remain unknown. A few reports have discussed POPF after distal pancreatectomy performed in patients with advanced ovarian cancer; however, only approximately 20 patients underwent this operation [ 26 27 ]. Therefore, it is difficult to definitively establish the risk factors and predictors based on investigation of a small number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is difficult to definitively establish the risk factors and predictors based on investigation of a small number of patients. Sozzi et al [ 26 ] reported that hyperthermic intraperitoneal chemotherapy and cholecystectomy were independently associated with POPF in 22 patients who underwent distal pancreatectomy during ovarian cancer surgery. However, to date, hyperthermic intraperitoneal chemotherapy is not accepted as the standard treatment in clinical practice, and cholecystectomy is rarely performed as a component of advanced ovarian cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of postoperative pancreatic fistula after splenectomy with or without distal pancreatectomy performed as a component of cytoreductive surgery for advanced ovarian cancer

et al. 2022

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Objective Splenectomy with or without distal pancreatectomy is occasionally performed during cytoreductive surgery for advanced ovarian cancer. We investigated pre-, intra-, postoperative risk factors and predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) in patients who underwent cytoreductive surgery for advanced ovarian cancer. Methods We investigated 165 consecutive patients with ovarian, fallopian tube, and peritoneal carcinoma categorized as stage III/IV disease, who underwent splenectomy with or without distal pancreatectomy as a component of cytoreductive surgery performed as initial treatment at Chiba University Hospital. Patient characteristics, clinical factors, and surgical outcomes were compared between those with and without CR-POPF. Results CR-POPF occurred in 20 patients (12%). There were no significant intergroup differences in the characteristics between patients with CR-POPF and patients without CR-POPF except for operative time, intraoperative blood loss, amylase (AMY) levels in drain fluid on postoperative day (POD)1 and POD3, and pancreatic stump thickness. Multivariate analysis showed that the POD3 drain fluid AMY level was the only significant risk factor and predictor of CR-POPF in patients who underwent cytoreductive surgery for advanced ovarian cancer. The receiver operating characteristic curve of the POD3 drain fluid AMY level, which predicted development of CR-POPF showed an area under the curve of 0.77, and the optimal cut-off value of AMY was 808 U/L. A pancreatic fistula did not occur in patients with POD3 drain fluid AMY levels <130 U/L. Conclusion The POD3 drain fluid AMY level can be early diagnostic predictor CR-POPF after splenectomy with or without distal pancreatectomy for advanced ovarian cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of postoperative pancreatic fistula after splenectomy with or without distal pancreatectomy performed as a component of cytoreductive surgery for advanced ovarian cancer

et al. 2022

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“…Among the multiquadrant surgical procedures usually required, bowel resections are the most common and the most frequently associated with severe postoperative complications. [6][7][8][9] Albeit rare, anastomosis leakage (AL) is a life-threatening condition; its incidence varies widely in OC literature, ranging from 2.7 to 16.9%. 7,[10][11][12][13][14][15][16][17][18][19] AL is associated with prolonged hospitalization and increased time to chemotherapy, with negative impact on overall survival (OS).…”

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confidence: 99%

Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience

et al. 2022

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Background Cytoreductive surgery is currently the main treatment for advanced epithelial ovarian cancer (OC), and several surgical maneuvers, including colorectal resection, are often needed to achieve no residual disease. High surgical complexity carries an inherent risk of postoperative complications, including anastomosis leakage (AL). Albeit rare, AL is a life-threatening condition. The aim of this single-center retrospective study is to assess the AL rate in patients undergoing colorectal resection and anastomosis during primary surgery for advanced epithelial OC through a standardized surgical technique and to evaluate possible pre/intra- and postoperative risk factors to identify the population at greatest risk. Methods A retrospective analysis of clinical and surgical characteristics of 515 patients undergoing colorectal resection and anastomosis during primary or interval debulking surgery between December 2011 and October 2019 was performed. Several pre/intra- and postoperative variables were evaluated by multivariate analysis as potential risk factors for AL. Results The overall anastomotic leakage rate was 2.9% (15/515) with a significant negative impact on postoperative course. Body mass index < 18 kg/m2, preoperative albumin value lower than 30 mg/dL, section of the inferior mesenteric artery at its origin, and medium–low colorectal anastomosis (< 10 cm from the anal verge) were identified as independent risk factors for AL on multivariate analysis. Conclusions AL is confirmed to be an extremely rare but severe postoperative complication of OC surgery, being responsible for increased early postoperative mortality. Preoperative nutritional status and surgical characteristics, such as blood supply and anastomosis level, appear to be the most significant risk factors.

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“…A protective stoma was not routine and was performed at the surgeon’s discretion. The upper abdominal surgical procedures refer to the surgical cytoreduction of tumours in the upper abdominal region, which includes diaphragm peritonectomy/resection, splenectomy, and distal pancreatectomy [ 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients

Wang²,

Chen

et al. 2022

BMC Surg

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Background To review the utilization of bowel resection in ovarian cancer surgery in our institution. Methods All ovarian cancer patients who received bowel resection between 2006/01 and 2018/12 were identified. Postoperative morbidities were assessed according to the Clavien–Dindo classification (CDC). Results There were 182 patients in the anastomosis group and 100 patients in the ostomy group, yielding a total of 282 patients. The median age was 57 years, and most patients had high-grade serous histology (88.7%). Forty-nine (17.3%) patients received neoadjuvant chemotherapy. During the operation, 78.7% of patients had ascites, and the median volume was 800 mL. Extensive bowel resection (at least two-segment) and upper abdominal operation were performed in 29 (10.2%) and 69 (24.4%) patients, respectively. The rectosigmoid colon was the most commonly resected (83.8%) followed by right hemicolectomy (5.9%) and small bowel resection (2.8%). No macroscopic residual disease was observed in 42.9% of the patients, whereas 87.9% had residual disease ≤ 1 cm. Among the entire cohort, 23.0% (65/282) experienced different complications. Severe complications (CDC 3–5) accounted for 9.2% of complications and were mostly categorized as pleural effusion requiring drainage (3.5%) followed by wound dehiscence requiring delayed repair in the operating room (1.8%). Nine patients experienced anastomotic leakage (AL): one in the ostomy group with extensive bowel resection and eight in the anastomosis group. The overall AL rate was 4.2% (9/212) per anastomosis. Conclusions The execution of bowel resection as part of debulking surgery in patients with newly diagnosed ovarian cancer resulted in a severe morbidity rate of 9.2%.

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Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience

Cited by 8 publications

References 32 publications

Predictors of postoperative pancreatic fistula after splenectomy with or without distal pancreatectomy performed as a component of cytoreductive surgery for advanced ovarian cancer

Predictors of postoperative pancreatic fistula after splenectomy with or without distal pancreatectomy performed as a component of cytoreductive surgery for advanced ovarian cancer

Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience

The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients

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