Department of Gynecologic Oncology, University of Palermo, Palermo, Italy.
Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy.
Arch Gynecol Obstet. 2020 Sep;302(3):707-714. doi: 10.1007/s00404-020-05684-2. Epub 2020 Jul 9.
To evaluate the incidence, predictors and clinical outcome of pancreatic fistulas in patients receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer.
Data of women who underwent splenectomy during cytoreduction for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Surgical, post-operative and follow-up data were analysed.
Overall, 260 patients were included in the study. Pancreatic resection was performed in 45 (17.6%) women, 23 of whom received capsule resection alone, while 22 required tail resection. Hyperthermic intraperitoneal chemotherapy (HIPEC) was administered in 28 (10.8%) patients. In the overall population, a pancreatic fistula was detected in 32 (12.3%) patients, and pancreatic resection (p-value = 0.033) and HIPEC administration (p-value = 0.039) were associated with fistula development. In multivariate analysis, HIPEC (OR = 2.573; p-value = 0.058) was confirmed as a risk factor for fistula development in women receiving splenectomy alone, while concomitant cholecystectomy (OR = 2.680; p-value = 0.012) was identified as the only independent predictor of the occurrence of pancreatic fistulas in those receiving additional distal pancreatectomy. Although the median length of hospital stay was higher in women with pancreatic leakage (p-value = 0.008), the median time from surgery to adjuvant treatment was not significantly increased.
HIPEC was identified as a risk factor for pancreatic fistulas in patients who underwent splenectomy alone, while concomitant cholecystectomy was the only independent predictor of fistula in those receiving additional pancreatectomy. The development of pancreatic leakage was not associated with increased post-operative mortality or delay in the initiation of chemotherapy.
评估接受细胞减灭术治疗晚期或复发性卵巢癌时行脾切除术患者胰瘘的发生率、预测因素和临床结局。
回顾性检索 5 家机构的肿瘤数据库中 2012 年 12 月至 2018 年 5 月期间接受细胞减灭术治疗晚期或复发性卵巢癌时行脾切除术的女性患者数据。分析手术、术后和随访数据。
共有 260 例患者纳入研究。45 例（17.6%）患者接受了胰腺切除术，其中 23 例仅行包膜切除术，22 例需要行胰尾切除术。28 例（10.8%）患者接受了腹腔热灌注化疗（HIPEC）。在总体人群中，32 例（12.3%）患者发生胰瘘，胰腺切除术（p 值=0.033）和 HIPEC 治疗（p 值=0.039）与瘘管形成相关。多变量分析显示，HIPEC（OR=2.573；p 值=0.058）被确认为仅行脾切除术的女性发生瘘管的危险因素，而同期胆囊切除术（OR=2.680；p 值=0.012）是接受附加胰远端切除术患者发生胰瘘的唯一独立预测因素。尽管胰瘘患者的中位住院时间较长（p 值=0.008），但从手术到辅助治疗的中位时间并未显著增加。
HIPEC 被确定为仅行脾切除术患者发生胰瘘的危险因素，而同期胆囊切除术是接受附加胰切除术患者发生瘘管的唯一独立预测因素。胰瘘的发生与术后死亡率增加或化疗开始延迟无关。
