PMID- 30535935 OWN - NLM STAT- MEDLINE DCOM- 20200518 LR - 20200518 IS - 1432-2218 (Electronic) IS - 0930-2794 (Linking) VI - 33 IP - 10 DP - 2019 Oct TI - The treatment indication and optimal management of fluid collection after laparoscopic distal pancreatectomy. PG - 3314-3324 LID - 10.1007/s00464-018-06621-w [doi] AB - BACKGROUND: Recently, laparoscopic distal pancreatectomy (LDP) has become the standard procedure for resection of left-sided pancreatic tumors. Fluid collection (FC) at the resection margin of the pancreatic stump after LDP is a frequent radiological finding. However, there have been few treatment guidelines and the optimal management for this clinical finding is unclear. The aim of present study is to define the incidence of FC and suggest the optimal management for FC after LDP. METHODS: A total of 1227 patients who underwent LDP between March 2005 and December 2015 were collected. FC was considered present when the longest diameter of the lesion on CT scan was > 3 cm. RESULTS: A follow-up with at least two CT image was available for 1102 patients. Of these, 689 (62.5%) patients showed initial fluid collection (IFC) at the pancreas resection site in immediate postoperative CT. IFC (+) group had higher proportion of men, BMI, and higher rate of concomitant splenectomy than IFC (-) group. Among patients with FC after LDP, the treatment group had more frequent leukocytosis and accompanying symptoms than the observation group. Seventy-seven patients underwent therapeutic interventions for FC after LDP. Among them, 55 (71.4%) patients underwent endoscopic ultrasonography-guided gastrocystostomy (EUS-GC). EUS-GC group had a higher success rate (85.6 vs. 63.6%, p < 0.033) and shorter hospital stay after the intervention (5.2 vs. 13.3 days, p < 0.001) than those who underwent other procedures. CONCLUSIONS: High BMI, male, and concomitant splenectomy contribute to the occurrence of FC after LDP. In most cases, FC after LDP resolved spontaneously over time with observation. The patients with symptomatic FC ultimately required treatment. EUS-GC is the optimal intervention therapy for FC after LDP. FAU - Song, Ki Byung AU - Song KB AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Kwon, Jaewoo AU - Kwon J AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Lee, Young-Joo AU - Lee YJ AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Hwang, Dae Wook AU - Hwang DW AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Lee, Jae Hoon AU - Lee JH AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Shin, Sang Hyun AU - Shin SH AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Kim, Myung-Hwan AU - Kim MH AD - Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Lee, Sung Koo AU - Lee SK AD - Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Seo, Dong-Wan AU - Seo DW AD - Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Lee, Sang Soo AU - Lee SS AD - Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Park, Do Hyun AU - Park DH AD - Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Song, Tae Jun AU - Song TJ AD - Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. FAU - Park, Guisuk AU - Park G AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Park, Yejong AU - Park Y AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Lee, Seung Jae AU - Lee SJ AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. FAU - Kim, Song Cheol AU - Kim SC AD - Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. drksc@amc.seoul.kr. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20181207 PL - Germany TA - Surg Endosc JT - Surgical endoscopy JID - 8806653 SB - IM MH - Cross-Sectional Studies MH - Humans MH - Laparoscopy/*methods MH - Pancreatectomy/*methods MH - Pancreatic Neoplasms/diagnosis/*surgery MH - Postoperative Care/*methods MH - Retrospective Studies MH - Seroma/diagnosis/*therapy MH - Tomography, X-Ray Computed MH - Treatment Outcome OTO - NOTNLM OT - Complication OT - Endoscopic ultrasonography OT - Fluid collection OT - Laparoscopic distal pancreatectomy OT - Symptom EDAT- 2018/12/12 06:00 MHDA- 2020/05/19 06:00 CRDT- 2018/12/12 06:00 PHST- 2018/07/02 00:00 [received] PHST- 2018/12/04 00:00 [accepted] PHST- 2018/12/12 06:00 [pubmed] PHST- 2020/05/19 06:00 [medline] PHST- 2018/12/12 06:00 [entrez] AID - 10.1007/s00464-018-06621-w [pii] AID - 10.1007/s00464-018-06621-w [doi] PST - ppublish SO - Surg Endosc. 2019 Oct;33(10):3314-3324. doi: 10.1007/s00464-018-06621-w. Epub 2018 Dec 7.