The Impact of Stump Closure Techniques on Pancreatic Fistula Stratified by the Thickness of the Pancreas in Distal Pancreatectomy.
Adult
Age Factors
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Operative Time
Organ Size
Pancreas
/ pathology
Pancreatectomy
/ adverse effects
Pancreatic Fistula
/ etiology
Pancreatic Neoplasms
/ surgery
Postoperative Complications
/ etiology
ROC Curve
Retrospective Studies
Risk Factors
Surgical Stapling
/ adverse effects
Young Adult
Clamp-crushing method
Distal pancreatectomy
Pancreatic fistula
Thickness
Journal
Digestive surgery
ISSN: 1421-9883
Titre abrégé: Dig Surg
Pays: Switzerland
ID NLM: 8501808
Informations de publication
Date de publication:
2020
2020
Historique:
received:
17
04
2019
accepted:
26
11
2019
pubmed:
28
1
2020
medline:
21
4
2021
entrez:
28
1
2020
Statut:
ppublish
Résumé
The purpose of this retrospective study was to evaluate the impact of stump closure techniques on pancreatic fistula (PF) focusing on pancreatic thickness after distal pancreatectomy (DP). A total of 213 patients who underwent DP between 2007 and 2017 were retrospectively reviewed. The risk factors of PF were investigated. In all patients, age ≥65 years (odds ratio [OR]: 3.60, p = 0.012), operation time ≥300 min (OR: 3.05, p = 0.013) and thickness of transected pancreas (OR: 1.37, p < 0.001) were identified as independent risk factors for clinically relevant PF. A receiver operating curve analysis revealed the optimum cut-off values of thickness to be 14 mm with stapler closure and 17 mm with the clamp-crushing method. There were no significant differences regarding PF between the stapler closure and clamp-crushing methods in the thin (<14 mm) and very thick pancreas (≥17 mm) groups (p = 0.822, p = 0.072). In contrast, stapler closure was the only independent risk factor for developing PF in the moderately thick (≥14, <17 mm) pancreas group (OR: 6.75 and p = 0.004, respectively). The clamp-crushing method was superior to stapler closure for pancreatic transection, especially in patients with moderately thick pancreas.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this retrospective study was to evaluate the impact of stump closure techniques on pancreatic fistula (PF) focusing on pancreatic thickness after distal pancreatectomy (DP).
METHODS
METHODS
A total of 213 patients who underwent DP between 2007 and 2017 were retrospectively reviewed. The risk factors of PF were investigated.
RESULTS
RESULTS
In all patients, age ≥65 years (odds ratio [OR]: 3.60, p = 0.012), operation time ≥300 min (OR: 3.05, p = 0.013) and thickness of transected pancreas (OR: 1.37, p < 0.001) were identified as independent risk factors for clinically relevant PF. A receiver operating curve analysis revealed the optimum cut-off values of thickness to be 14 mm with stapler closure and 17 mm with the clamp-crushing method. There were no significant differences regarding PF between the stapler closure and clamp-crushing methods in the thin (<14 mm) and very thick pancreas (≥17 mm) groups (p = 0.822, p = 0.072). In contrast, stapler closure was the only independent risk factor for developing PF in the moderately thick (≥14, <17 mm) pancreas group (OR: 6.75 and p = 0.004, respectively).
CONCLUSION
CONCLUSIONS
The clamp-crushing method was superior to stapler closure for pancreatic transection, especially in patients with moderately thick pancreas.
Identifiants
pubmed: 31986517
pii: 000505061
doi: 10.1159/000505061
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
340-347Informations de copyright
© 2020 S. Karger AG, Basel.