Incidence of clinically relevant postoperative pancreatic fistula in patients undergoing open and minimally invasive pancreatoduodenectomy: a population-based study.

Journal of minimally invasive surgery Pub Date : 2024-06-15 DOI:10.7602/jmis.2024.27.2.95

Jenny H Chang, Rasha T Kakati, Chase Wehrle, Robert Naples, Daniel Joyce, Toms Augustin, Robert Simon, R Matthew Walsh, Fadi S Dahdaleh, Philip Spanheimer, Isabella Salti, Alessandro Parente, Samer A Naffouje

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引用次数: 0

Abstract

Purpose: Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset (2014-2020) was reviewed for any POPF after OPD. Propensity score matching (PSM) compared MIPD to OPD, and then RPD to LPD.

Results: Among 3,083 patients who developed a POPF, 2,843 (92.2%) underwent OPD and 240 (7.8%) MIPD; of these, 25.0% were LPD (n = 60) and 75.0% RPD (n = 180). Grade B POPF was observed in 45.4% (n = 1,400), and grade C in 6.0% (n = 185). After PSM, MIPD patients had higher rates of CR-POPF (47.3% OPD vs. 54.4% MIPD, p = 0.037), as well as higher reoperation (9.1% vs. 15.3%, p = 0.006), delayed gastric emptying (29.2% vs. 35.8%, p = 0.041), and readmission rates (28.2% vs. 35.1%, p = 0.032). However, CR-POPF rates were comparable between LPD and RPD (56.8% vs. 49.3%, p = 0.408).

Conclusion: The impact of POPF is more clinically pronounced after MIPD than OPD with a more complex postoperative course. The difference appears to be attributed to the minimally invasive environment itself as no difference was noted between LPD and RPD. A clear biological explanation of this clinical observation remains missing. Further studies are warranted.

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开放式和微创胰十二指肠切除术患者术后临床相关胰瘘的发生率：一项基于人群的研究。

目的：术后胰瘘（POPF）仍然是胰十二指肠切除术（PD）的一种破坏性并发症。微创胰十二指肠切除术（MIPD），包括腹腔镜（LPD）和机器人（RPD）方法，其胰瘘发生率与开腹胰十二指肠切除术（OPD）相当。然而，我们假设，与开腹手术相比，MIPD发生更严重POPF（定义为临床相关POPF（CR-POPF））的可能性更高：方法：对美国外科学院国家外科质量改进计划（ACS NSQIP）目标胰腺切除术数据集（2014-2020 年）进行了回顾性分析，以了解 OPD 后出现任何 POPF 的情况。倾向得分匹配（PSM）比较了MIPD和OPD，然后是RPD和LPD：在 3,083 例出现 POPF 的患者中，2,843 例（92.2%）接受了 OPD，240 例（7.8%）接受了 MIPD；其中，25.0% 为 LPD（n = 60），75.0% 为 RPD（n = 180）。45.4% 的患者（n = 1,400 例）出现 B 级 POPF，6.0% 的患者（n = 185 例）出现 C 级 POPF。PSM 后，MIPD 患者的 CR-POPF 发生率更高（47.3% OPD vs. 54.4% MIPD，p = 0.037），再次手术率（9.1% vs. 15.3%，p = 0.006）、胃排空延迟率（29.2% vs. 35.8%，p = 0.041）和再次入院率（28.2% vs. 35.1%，p = 0.032）也更高。然而，LPD和RPD的CR-POPF率相当（56.8% vs. 49.3%，p = 0.408）：结论：MIPD术后POPF的临床影响比OPD更明显，术后过程更复杂。这种差异似乎归因于微创环境本身，因为LPD和RPD之间没有差异。这一临床观察结果仍然缺乏明确的生物学解释。有必要进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Journal of minimally invasive surgery

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