Ricerc@Sapienza

Background/Aim: The purpose of this study was to evaluate the results of stapled
closure of the pancreatic remnant after cold-knife section of the pancreatic isthmus and
distal pancreatectomy for adenocarcinoma.
Methods: A retrospective evaluation of 57 consecutive patients undergoing distal
spleno-pancreatectomy for adenocarcinoma was performed. The pancreatic isthmus
was systematically straight-sectioned with a cold knife, and the remnant was stapled
close without additional stitches or adjuncts. The study’s main endpoints were
postoperativemortality, the occurrence of a pancreatic fistula, the need for a re-operation,
the postoperative length of stay in the hospital, the rate of re-admission, and late survival.
Results: Postoperative mortality was absent. Seventeen patients (29.8%) presented a
pancreatic fistula of grade A in seven cases (41.2%), grade B in eight cases (47.1%),
and grade C in two cases (11.8%). Re-operation was required in the two patients
(3.5%) with grade C fistula in order to drain an intra-abdominal abscess. The mean
postoperative length of stay in the hospital was 15 days (range, 6–62 days). No patient
required re-admission. Twenty-nine patients (50.8%) were alive and free from disease,
respectively, 12 patients (21.1%) at 12 months, 13 patients (22.8%) at 60 months, and
four patients (7.0%) at 120 months from the operation. The remaining patients died of
metastatic disease 9–37 months from the operation. Lastly, disease-related mortality
was 49.1%.
Conclusion: Stapler closure of the pancreatic remnant allows good postoperative
results, limiting the formation of pancreatic fistula to the lower limit of its overall
reported incidence.