Incidence and early prediction of postoperative pancreatic fistula after splenectomy in ovarian cancer cytoreduction within an ERAS pathway: the ERASPLEEN study.

Résumé fourni par la source

Objective To estimate the incidence of clinically relevant postoperative pancreatic fistula in patients undergoing splenectomy without concurrent pancreatic procedure during cytoreductive surgery for advanced or recurrent ovarian cancer within an Enhanced Recovery After Surgery (ERAS) protocol, and, secondarily, to describe the perioperative course and explore factors associated with grade B fistula. Methods Prospective single-centre phase II study. Postoperative pancreatic fistula was defined and graded per the 2016 International Study Group on Pancreatic Surgery (ISGPS) criteria until postoperative day 30. Drain amylase and fluid output were recorded on postoperative day 3 and reassessed when abnormal. Prespecified univariate and multivariable analyses identified predictors of grade B fistula. Results Ninety-two patients were included. Pancreatic-related events occurred in 9.8% (9/92): biochemical leak in 4 (4.3%) and grade B fistula in 5 (5.4%), with no grade C events. Median length of stay for the whole cohort was 7 days (IQR 6–9), but grade B fistula extended it to 18 days (IQR 13–26) (p<0.001). Postoperative day 3 drain output was the only independent predictor of grade B fistula (OR 1.41, 95% CI 1.12–1.79, p=0.004). Conclusions Within an ERAS pathway, grade B postoperative pancreatic fistula occurred in 5.4% of patients undergoing splenectomy without pancreatic resection. Postoperative day 3 drain output was the only independent predictor and may enable early identification of high-risk patients and safe early discharge for those with low output, pending prospective validation.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.