Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remai...Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remains unclear.Methods:Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected.The outcomes of MDP with stapler and hand-sewn closure were compared.The primary outcome was clinically relevant postoperative pancreatic fistula(CR-POPF)per the International Study Group of Pancreatic Surgery definition.Results:Of the 384 patients(stapler closure,339;hand-sewn closure,45)enrolled,249 developed CR-POPF(grades B and C:242 and 7 patients,respectively).The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group(64.6%and 1.5%vs 51.1%and 4.4%,P=.078 and P=.223,respectively).No differences between the stapler and hand-sewn groups were observed regarding the median operation time(207 vs 222 minutes,P=.139),incidence of major complications(16.5%vs 20.0%,P=.559),and mortality(0.2%vs 0%,P=1.000).The independent risk factors of CR-POPF were abdominal abscess,prolonged operation time,and transection site(P=.004,.006,and.001,respectively).Conclusion:The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort.Randomized controlled trials are needed to verify this finding.展开更多
基金supported by the National Key Research and Development Program(No.2019YFC1316000)the National Natural Science Foundation of China(No.82071748,No.82188102)the Innovation Center for the Study of Pancreatic Diseases,Zhejiang Province(ICSPD-ZJ).
文摘Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remains unclear.Methods:Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected.The outcomes of MDP with stapler and hand-sewn closure were compared.The primary outcome was clinically relevant postoperative pancreatic fistula(CR-POPF)per the International Study Group of Pancreatic Surgery definition.Results:Of the 384 patients(stapler closure,339;hand-sewn closure,45)enrolled,249 developed CR-POPF(grades B and C:242 and 7 patients,respectively).The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group(64.6%and 1.5%vs 51.1%and 4.4%,P=.078 and P=.223,respectively).No differences between the stapler and hand-sewn groups were observed regarding the median operation time(207 vs 222 minutes,P=.139),incidence of major complications(16.5%vs 20.0%,P=.559),and mortality(0.2%vs 0%,P=1.000).The independent risk factors of CR-POPF were abdominal abscess,prolonged operation time,and transection site(P=.004,.006,and.001,respectively).Conclusion:The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort.Randomized controlled trials are needed to verify this finding.
