Incidence and early prediction of post-operative pancreatic fistula after splenectomy in ovarian cancer cytoreduction within an enhanced recovery after surgery pathway: the ERASPLEEN study.
Marco D'Indinosante, Nicolò Bizzarri, Alice Zampolini Faustini et al.
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In 30 seconds
The ERASPLEEN study was a prospective, single-centre phase II study of 92 patients undergoing splenectomy without pancreatic resection during cytoreductive surgery for advanced or recurrent ovarian cancer within an enhanced recovery pathway. By postoperative day 30, five patients (5.4%) developed grade B pancreatic fistula; no grade C events occurred. Postoperative day 3 drain output was the only independent predictor of grade B fistula (odds ratio 1.41, 95%, confidence interval 1.12 to 1.79, p = .004). Grade B fistula was associated with a longer hospital stay.
Key findings
- Pancreatic-related events occurred in 9.8% (9/92), including biochemical leak in 4 (4.3%) and grade B fistula in 5 (5.4%); there were no grade C events.
- Median hospital stay was 7 days (interquartile range 6 to 9) overall and 18 days (interquartile range 13 to 26) with grade B fistula (p < .001).
- Post-operative day 3 drain output was the only independent predictor of grade B fistula (odds ratio 1.41, 95%, confidence interval 1.12 to 1.79, p = .004).
Why it matters
Clinically relevant pancreatic fistula was uncommon but associated with substantially longer hospitalisation in this cohort. The association with postoperative day 3 drain output suggests a potentially useful early risk marker in this surgical setting, while the study’s findings also provide an estimate of fistula incidence within an enhanced recovery pathway.
What to keep in mind
The study was prospective but single-centre and included 92 patients. The proposed use of drain output to guide early identification and discharge requires prospective validation.