Introduction/Background The aim of the surgical treatment of advanced ovarian cancer is to completely remove all macroscopic disease.To achieve optimal cytoreduction, the use of extensive upper abdominal surgery has become widely accepted.Although the disease doesn’t usually invade the splenic parenchyma, the capsule may commonly be infiltrated. These metastases may be difficult to be dissected from the pancreatic tail and a partial pancreatic resection en bloc with spleen may be required. The objective of this study is to evaluate predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer.
Methodology Data of women receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Criteria’s used to identify pancreatic leaks were measurement of lipase and amylase level on peri-pancreatic drainage fluid, imaging and abdominal pain referable to pancreatitis.Surgical and post-operative data were analyzed.
Results Overall 260 patients were included in the study.Pancreatic resection was performed in 45 (17.6%) women, among them 23 patients received only pancreatic capsule resection and 22 received distal pancreatic tail resection. Intraperitoneal hypertermic chemotherapy (HIPEC) was performed in 28 (10.8%) cases. Pancreatic fistula was detected in 32 (12.3%) cases. At multivariable analysis pancreatic resection (OR: 2.064; p: 0.040), in particular pancreatic tail resection (OR:3.055; p: 0.003) and HIPEC administration (OR: 1.910; p: 0.057) were identified as independent predictors of pancreatic fistula.
Conclusion Twelve percent of patients who received splenectomy during cytoreductive surgery for ovarian cancer developed a pancreatic leak.Distal pancreatectomy and HIPEC administration have been identified as independent predictors of pancreatic fistula in this subset of patients. No significant delay in initiation of adjuvant chemotherapy was observed in women with leakage.
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