Lihan Qian1,2,3, Binwei Hu1,2,3, Jiancheng Wang1,2,3, Xiongxiong Lu1,2,3, Xiaxing Deng1,2,3, Weimin Chai4, Zhiwei Xu5,6,7, Weishen Wang8,9,10, Baiyong Shen11,12,13. 1. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China. 2. Research Institute of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, China. 3. State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiaotong University, Shanghai, China. 4. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 5. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China. xuzhiwei10800@163.com. 6. Research Institute of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, China. xuzhiwei10800@163.com. 7. State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiaotong University, Shanghai, China. xuzhiwei10800@163.com. 8. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China. peanutswey@hotmail.com. 9. Research Institute of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, China. peanutswey@hotmail.com. 10. State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiaotong University, Shanghai, China. peanutswey@hotmail.com. 11. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China. shenby@shsmu.edu.cn. 12. Research Institute of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, China. shenby@shsmu.edu.cn. 13. State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiaotong University, Shanghai, China. shenby@shsmu.edu.cn.
Abstract
OBJECTIVES: Postoperative pancreatic fistula (POPF) is the main complication of distal pancreatectomy (DP) and affects the prognosis of patients. The impact of several clinical factors mentioned in recent studies on POPF remains controversial. This study aimed to investigate the impact of a remnant pancreas and other perioperative factors on POPFs occurring after robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms. METHODS: A total of 197 patients who received robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms at the Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2018 to December 2020 were included in this retrospective study. According to the intraoperative transection plan, patients were divided into an RDP body group and an RDP tail group. Clinical and pathological features and perioperative factors affecting POPF were analyzed and compared between the two groups. RESULTS: The results showed that a transection plan involving the tail of the pancreas (OR = 2.133, 95% CI 1.109-4.103, p = 0.023) and spleen preservation (OR = 2.588, 95% CI 1.435-4.665, p = 0.001) independently increased the incidence of POPF in patients with nonmalignant pancreatic neoplasms treated by RDP. A transection plan involving the tail of the pancreas was also an independent risk factor (OR = 3.464, 95% CI 1.270-9.450, p = 0.015) for grade B/C POPF. Length of remnant pancreas > 6.23 cm was an independent risk factor for POPF (OR = 3.116, 95% CI 1.364-7.121, p = 0.007). Length of remnant pancreas > 9.82 cm was an independent risk factor for grade B/C POPF (OR = 3.340, 95% CI 1.386-8.051, p = 0.007). CONCLUSION: This retrospective study suggests that a transection plan involving the tail of the pancreas is an independent risk factor for POPF in patients with nonmalignant neoplasms treated by RDP. We also propose that the postoperative length of the remnant pancreas evaluated by computed tomography scans can be used to identify patients with a high risk of POPF in order to optimize the individualized strategy.
OBJECTIVES: Postoperative pancreatic fistula (POPF) is the main complication of distal pancreatectomy (DP) and affects the prognosis of patients. The impact of several clinical factors mentioned in recent studies on POPF remains controversial. This study aimed to investigate the impact of a remnant pancreas and other perioperative factors on POPFs occurring after robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms. METHODS: A total of 197 patients who received robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms at the Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2018 to December 2020 were included in this retrospective study. According to the intraoperative transection plan, patients were divided into an RDP body group and an RDP tail group. Clinical and pathological features and perioperative factors affecting POPF were analyzed and compared between the two groups. RESULTS: The results showed that a transection plan involving the tail of the pancreas (OR = 2.133, 95% CI 1.109-4.103, p = 0.023) and spleen preservation (OR = 2.588, 95% CI 1.435-4.665, p = 0.001) independently increased the incidence of POPF in patients with nonmalignant pancreatic neoplasms treated by RDP. A transection plan involving the tail of the pancreas was also an independent risk factor (OR = 3.464, 95% CI 1.270-9.450, p = 0.015) for grade B/C POPF. Length of remnant pancreas > 6.23 cm was an independent risk factor for POPF (OR = 3.116, 95% CI 1.364-7.121, p = 0.007). Length of remnant pancreas > 9.82 cm was an independent risk factor for grade B/C POPF (OR = 3.340, 95% CI 1.386-8.051, p = 0.007). CONCLUSION: This retrospective study suggests that a transection plan involving the tail of the pancreas is an independent risk factor for POPF in patients with nonmalignant neoplasms treated by RDP. We also propose that the postoperative length of the remnant pancreas evaluated by computed tomography scans can be used to identify patients with a high risk of POPF in order to optimize the individualized strategy.
Authors: Claudio Bassi; Giovanni Marchegiani; Christos Dervenis; Micheal Sarr; Mohammad Abu Hilal; Mustapha Adham; Peter Allen; Roland Andersson; Horacio J Asbun; Marc G Besselink; Kevin Conlon; Marco Del Chiaro; Massimo Falconi; Laureano Fernandez-Cruz; Carlos Fernandez-Del Castillo; Abe Fingerhut; Helmut Friess; Dirk J Gouma; Thilo Hackert; Jakob Izbicki; Keith D Lillemoe; John P Neoptolemos; Attila Olah; Richard Schulick; Shailesh V Shrikhande; Tadahiro Takada; Kyoichi Takaori; William Traverso; Charles R Vollmer; Christopher L Wolfgang; Charles J Yeo; Roberto Salvia; Marcus Buchler Journal: Surgery Date: 2016-12-28 Impact factor: 3.982
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Authors: Yi Miao; Zipeng Lu; Charles J Yeo; Charles M Vollmer; Carlos Fernandez-Del Castillo; Paula Ghaneh; Christopher M Halloran; Jörg Kleeff; Thijs de Rooij; Jens Werner; Massimo Falconi; Helmut Friess; Herbert J Zeh; Jakob R Izbicki; Jin He; Johanna Laukkarinen; Cees H Dejong; Keith D Lillemoe; Kevin Conlon; Kyoichi Takaori; Luca Gianotti; Marc G Besselink; Marco Del Chiaro; Marco Montorsi; Masao Tanaka; Maximilian Bockhorn; Mustapha Adham; Attila Oláh; Roberto Salvia; Shailesh V Shrikhande; Thilo Hackert; Tooru Shimosegawa; Amer H Zureikat; Güralp O Ceyhan; Yunpeng Peng; Guangfu Wang; Xumin Huang; Christos Dervenis; Claudio Bassi; John P Neoptolemos; Markus W Büchler Journal: Surgery Date: 2020-04-02 Impact factor: 3.982
Authors: Fee Klupp; Miriam Klauss; Nuh N Rahbari; Klaus Felix; Ulf Hinz; Ines Manglberger; Frank Bergmann; Matthias M Gaida; Thilo Hackert; Oliver Strobel; Markus W Büchler Journal: Surgery Date: 2019-10-18 Impact factor: 3.982