Comparison of Outcomes with Stapler Versus Hand-Sewn Closure of the Pancreatic Stump following Minimally Invasive Distal Pancreatectomy: A Retrospective Cohort Study

Tao Qian, Kaiquan Huang, Wenqing Chen, X. Bai, Shunliang Gao, Yan Shen, M. Zhang, Jian Wu, Jun Yu, T. Ma, T. Liang
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Abstract

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. 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. 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 = 0.078 and P = 0.223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 min vs. 222 min, P = 0.139), incidence of major complications (16.5% vs. 20.0%, P = 0.559), 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 = 0.004, 0.006, and 0.001, respectively). 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.
微创远端胰腺切除术后吻合吻合钉与手缝合胰腺残端的疗效比较:一项回顾性队列研究
胰远端切除术后的胰瘘是一种常见且可能致命的并发症。微创远端胰切除术(MDP)中胰腺残余物的最佳闭合方法尚不清楚。收集了2018年7月至2021年6月期间在我们机构接受MDP的连续患者的数据。比较使用缝合器和手工缝合闭合器进行MDP的结果。根据国际胰腺外科研究小组的定义,主要结果是临床相关的术后胰瘘(CR-POPF)。在384名入选患者(缝合器闭合,339名;手工缝合闭合,45名)中,249名患者出现CR-POPF(B级和C级:分别为242名和7名患者)。缝合器组的B级和C级POPF发生率与手工缝合组的相应发生率相似(分别为64.6%和1.5%,51.1%和4.4%,P=0.078和P=0.023)。缝合器组和手工缝合组在中位手术时间方面没有观察到差异(207 最小值与222 min,P=0.139),主要并发症发生率(16.5%vs.20.0%,P = 0.559)和死亡率(0.2%对0%,P=0.000)。CR-POPF的独立危险因素是腹部脓肿、手术时间延长和横断部位(分别为P=0.004、0.006和0.001)。在这一回顾性队列中,通过胰残端缝合器闭合CR-POPF的发生率和严重程度与MDP中手工缝合闭合的发生率及严重程度相当。需要进行随机对照试验来验证这一发现。
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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