Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"Usefulness of intraoperative choledochoscopy in laparoscopic subtotal cholecystectomy for severe cholecystitis.","authors":"Rui-Hui Zhang, Xiang-Nan Wang, Yue-Feng Ma, Xue-Qian Tang, Mei-Ju Lin, Li-Jun Shi, Jing-Yi Li, Hong-Wei Zhang","doi":"10.14701/ahbps.25-010","DOIUrl":"10.14701/ahbps.25-010","url":null,"abstract":"<p><p>Laparoscopic subtotal cholecystectomy (LSC) has been a safe and viable alternative to conversion to laparotomy in cases of severe cholecystitis. The objective of this study is to determine the utility of intraoperative choledochoscopy in LSC for the exploration of the gallbladder, cyst duct, and subsequent stone clearance of the cystic duct in cases of severe cholecystitis. A total of 72 patients diagnosed with severe cholecystitis received choledochoscopy-assisted laparoscopic subtotal cholecystectomy (CALSC). A choledochoscopy was performed to explore the gallbladder cavity and/or cystic duct, and to extract stones using a range of techniques. The clinical records, including the operative records and outcomes, were subjected to analysis. No LSC was converted to open surgery, and no bile duct or vascular injuries were sustained. All stones within the cystic duct were removed by a combination of techniques, including high-frequency needle knife electrotomy, basket, and electrohydraulic lithotripsy. A follow-up examination revealed the absence of residual bile duct stones, with the exception of one common bile duct stone, which was extracted via endoscopic retrograde cholangiopancreatography. In certain special cases, CALSC may prove to be an efficacious treatment for the management of severe cholecystitis. This technique allows for optimal comprehension of the situation within the gallbladder cavity and cystic duct, facilitating the removal of stones from the cystic duct and reducing the residue of the non-functional gallbladder remnant.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":"29 2","pages":"192-198"},"PeriodicalIF":1.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive study on postoperative complications and postoperative pancreatic fistula in sporadic non-functional pancreatic neuroendocrine tumors: A retrospective cohort study.","authors":"Juwan Kim, Seung Soo Hong, Sung Hyun Kim, Ho Kyoung Hwang, Chang Moo Kang","doi":"10.14701/ahbps.24-215","DOIUrl":"10.14701/ahbps.24-215","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Balancing surgical risks and benefits is crucial for managing non-functional pancreatic neuroendocrine tumors (NF-PNETs). Despite high postoperative pancreatic fistula (POPF) rates, studies on postoperative complications of sporadic NF-PNETs are scarce. Thus, this study aimed to investigate postoperative complications and identify risk factors for POPF.</p><p><strong>Methods: </strong>A retrospective review of 166 NF-PNET surgeries performed at Severance Hospital between February 2000 and August 2023 was conducted.</p><p><strong>Results: </strong>Age > 65 years and higher American Society of Anesthesiology (ASA) grade were not significantly correlated with severe complications (odds ratio [OR]: 1.10, <i>p</i> = 0.871 and OR: 1.47, <i>p</i> = 0.491, respectively). Surgical procedures included enucleation (13.9%), distal pancreatectomy (50.0%), central pancreatectomy (4.8%), pancreaticoduodenectomy (PD) (26.5%), and total pancreatectomy (4.8%). Severe complications occurred in 12.05% of surgeries. The overall incidence of all POPFs including biochemical leaks was 53%, while clinically relevant POPF (grade B or C) occurred in 7.8% of patients. Logistic regression showed that PD (OR: 3.94, <i>p</i> = 0.092) tended to be risk factor for POPF and that diameter of the main pancreatic duct (MPD) ≤ 3 mm was a significant risk factor for POPF (OR: 0.22, <i>p</i> = 0.008). A pancreas thickness (PT)/MPD ratio > 4.47 on preoperative computed tomography predicted all POPFs in PD patients (OR: 11.70, <i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>Age and comorbidities had no significant impact on surgical outcomes. PD was associated with higher serious complications and POPF rates. The PT/MPD ratio is a valuable preoperative tool for predicting POPF risk in PD patients.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"168-176"},"PeriodicalIF":1.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term and long-term outcomes of pancreas preserving total duodenectomy: A case series from a single center with 13 years' experience and complimentary meta-analysis.","authors":"Mohammed Hammoda, Shahab Hajibandeh, Bilal Al-Sarireh","doi":"10.14701/ahbps.24-214","DOIUrl":"10.14701/ahbps.24-214","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD).</p><p><strong>Methods: </strong>A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series. All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis.</p><p><strong>Results: </strong>A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%-5.2%), CD II complications in 21.1% (14.6%-27.6%), CD III complications in 18.1% (9.3%-26.9%), CD IV complications in 2.7% (0.5%-4.9%), and CD V complications in 2.2% (0.2%-4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, <i>p</i> = 0.830), total complications (OR: 0.77, <i>p</i> = 0.440), postoperative pancreatic fistula (OR: 0.43, <i>p</i> = 0.140), delayed gastric emptying (OR: 0.70, <i>p</i> = 0.450), or postoperative bleeding (OR: 0.97, <i>p</i> = 0.960) between PPTD and pancreaticoduodenectomy.</p><p><strong>Conclusions: </strong>PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"157-167"},"PeriodicalIF":1.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of pancreato-duodenectomy for groove pancreatitis: A retrospective experience from a tertiary referral center.","authors":"Zeeshan Ahmed, Raviraj Tilloo, Monish Karunakaran, Shreeyash Modak, Prateek Arora, Sanjeev Patil, Anuradha Sekaran, Mohan Ramchandani, Mahesh Shetty, Rohit Dama, Pradeep Rebala, Guduru Venkat Rao","doi":"10.14701/ahbps.25-041","DOIUrl":"https://doi.org/10.14701/ahbps.25-041","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Groove pancreatitis (GP) is a seldom encountered form of chronic pancreatitis characterized by inflammation of the pancreatoduodenal groove. Our study presents our experience with pancreatoduodenectomy (PD) for GP at a tertiary referral center.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients who underwent PD for a preoperative diagnosis of GP at a tertiary referral center from 2010 to 2024. The primary outcomes were long-term pain relief and risks of recurrent pancreatitis, exocrine, and endocrine insufficiency. Secondary outcomes included perioperative complications.</p><p><strong>Results: </strong>During the study period, 19 patients underwent PD for GP. The median age was 45.5 years, and all patients were male. Eighty percent of the patients had a history of alcohol consumption and smoking. The median duration of symptoms was 24 months, with pain being the most prevalent symptom (94.73%). The overall complication rate (Clavien-Dindo grades 1-5) was 52.63% (10/19), and the major complication rate (Clavien-Dindo grades 3-5) was 21.05%. The median follow-up period was 67.25 months. Complete pain relief was achieved in 73.33% (11/15) of the patients, with the remaining 26.66% (4/15) experiencing partial resolution of pain. Among these, all had recurrent pancreatitis in the remnant pancreas, with ongoing alcohol consumption (n = 3) or smoking (n = 4). New-onset diabetes mellitus and steatorrhea were observed in 42.85% (6/14) and 21.42% (3/14) of patients, respectively. Furthermore, 71.42% (10/14) reported weight gain, with a median increase of 13.5 kg (range 5.00-22.75 kg).</p><p><strong>Conclusions: </strong>PD for GP offers substantial long-term pain relief with acceptable levels of perioperative morbidity and mortality.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and outcomes of pancreato-duodenectomy in portal annular pancreas: A single center experience with a systematic review of the literature.","authors":"Shreeyash Modak, Raviraj Tilloo, Zeeshan Ahmed, Monish Karunakaran, Sanjeev Patil, Mahesh Shetty, Rohit Dama, Pradeep Rebala, Guduru Venkat Rao","doi":"10.14701/ahbps.25-027","DOIUrl":"https://doi.org/10.14701/ahbps.25-027","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Portal annular pancreas (PAP) is an anomaly where pancreatic tissue surrounds the portal vein (PV). We present a case series from our institution and a systematic review of PAP patients who underwent pancreatoduodenectomy (PD).</p><p><strong>Methods: </strong>We conducted a retrospective review of patient records from a tertiary referral center, from January 2014 to June 2024, who underwent PD to identify those with PAP. Additionally, a literature search was performed and articles discussing PAP patients who underwent PD were included.</p><p><strong>Results: </strong>The incidence of PAP was 0.4% (7 out of 1,750 PD cases). Of these, three (42.85%) patients developed clinically relevant postoperative pancreatic fistula (CR-POPF). Following the literature review, 34 articles with 57 patients (including our study) were considered. Reconstruction of the dominant stump, which included the main pancreatic duct, was performed using pancreatojejunostomy in 88.88% of cases and pancreatogastrostomy in 11.11% of cases. The non-dominant stump was managed with en-bloc extended resection (ER) of PAP, leftward of the PV, offering a single-cut surface for pancreatojejunostomy (41.51%), by stapling (26.41%) or suturing the stump (16.98%), stump-pancreatogastrostomy (5.66%), and electrocautery (5.66%). CR-POPF rates for ER, suturing and stapling were 22.72%, 37.5%, and 53.85%, respectively (<i>p</i> = 0.12).</p><p><strong>Conclusions: </strong>Preoperative recognition of PAP is crucial to customize surgical procedures to effectively manage the non-dominant stump.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A positive resection margin does not determine long-term survival following colorectal liver metastasis resection.","authors":"Andreas Konstantinou, Sivasanker Masillamany, Ajit Thomas Abraham, Deepak Hariharan, Vincent Sui Kwong Yip, Hemant Mahendrakumar Kocher","doi":"10.14701/ahbps.24-233","DOIUrl":"https://doi.org/10.14701/ahbps.24-233","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>This study evaluates whether positive resection margins after colorectal liver metastasis (CRLM) surgery are linked to tumor recurrence and impact long-term survival.</p><p><strong>Methods: </strong>The oncological outcomes of patients undergoing curative resection for CRLM at a single institution were analyzed concerning clinicopathological factors using both univariate and multivariate statistical methods.</p><p><strong>Results: </strong>Among 138 patients who underwent liver resection for CRLM, hepatic tumor recurrence was noted in 70 patients (50.7%), with no significant difference between those with R0 and R1 resections (<i>p</i> = 0.33). Positive resection margins were associated with tumor proximity to major liver vascular structures, while negative margins corresponded more frequently with T4 stage colorectal cancer. Multivariate analysis indicated that R1 margins in CRLM resections do not affect overall or disease-free survival. Nonetheless, the proximity of tumors to major liver vascular structures and R1 margins from initial colorectal cancer resections were significant independent predictors of poorer survival outcomes.</p><p><strong>Conclusions: </strong>With the advent of modern perioperative systemic therapies, both hepatic recurrence and survival outcomes following hepatectomy for colorectal liver metastases seem unaffected by the presence of R1 resection margins.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of minimally invasive splenectomy with endotherapy for non-cirrhotic portal fibrosis: a retrospective cohort study.","authors":"Lokesh Agarwal, Sanjamjot Singh, Vaibhav Kumar Varshney, Subhash Chandra Soni, B Selvakumar, Peeyush Varshney, Shaikh Muna Afroz, Tashmeen Kaur Sethi, Binit Sureka","doi":"10.14701/ahbps.25-033","DOIUrl":"https://doi.org/10.14701/ahbps.25-033","url":null,"abstract":"<p><p>Non-cirrhotic portal fibrosis (NCPF), a leading cause of non-cirrhotic portal hypertension (NCPH), commonly presents with splenomegaly, esophageal varices, and preserved liver function. While minimally invasive splenectomy (MIS) offers advantages over open splenectomy, concerns persist due to the risks associated with portal hypertension. This study evaluates the feasibility, safety, and long-term outcomes of MIS in non-bleeder NCPF patients, highlighting perioperative challenges and techniques. Thirteen consecutive non-bleeder NCPF patients undergoing MIS between November 2017 and December 2023 were analyzed. Procedures included eight laparoscopic and four robotic splenectomies, with one conversion to open surgery. Additionally, two patients underwent laparoscopic and one robotic gastric devascularization. Perioperative parameters such as operative time, blood loss, hospital stay, and complications were recorded. The median operative time was 240 minutes, and median blood loss was 150 mL. One patient required transfusion, and one developed splanchnic venous thrombosis, managed conservatively. Median hospital stay was three days, with no 90-day mortality. Follow-up assessments included clinical evaluation, blood tests, Doppler ultrasound of the splenoportal axis, and upper gastrointestinal endoscopy. At a median follow-up of 16 months (interquartile range 12-43), significant improvements were observed in hemoglobin, leukocyte, and platelet counts (<i>p</i> < 0.01). Esophageal variceal grades decreased from 2 to 1, while portal vein peak systolic velocity improved from 18 to 27.7 cm/sec (<i>p</i> < 0.01), indicating reduced portal hypertension. No postoperative infections or variceal bleeding recurrences were noted. MIS is a safe and effective treatment option for non-bleeder NCPF with favorable long-term outcomes when performed by skilled surgeons.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting recurrence of pain after surgery for chronic pancreatitis: A retrospective and prospective study.","authors":"Sunil Kumar Godara, Shaganti Rakesh, Rahul, Sujeet Kumar Singh Gautam, Rajneesh Kumar Singh","doi":"10.14701/ahbps.25-001","DOIUrl":"https://doi.org/10.14701/ahbps.25-001","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Postoperative pain recurrence is a challenging issue in chronic pancreatitis (CP). This study explores the incidence and factors contributing to recurrent pain after surgery.</p><p><strong>Methods: </strong>An ambispective observational study evaluated patients with painful CP undergoing surgery from 2011 to 2022. The intensity frequency consequence (IFC) pain score and the painDETECT questionnaire were utilized to assess pain before and after surgery. Patients were categorized into 2 groups based on their IFC pain scores: a pain group and a pain-free group. Clinical, radiological, surgical, and post-surgical parameters were compared between these groups using the student t-test and logistic regression for continuous and categorical variables, respectively. A <i>p</i>-value of < 0.05 was deemed significant. Multivariate analysis was conducted.</p><p><strong>Results: </strong>A total of 125 patients were enrolled (pain group, 71 [56.8%]; pain-free group, 54 [43.2%]). In the pain group, 65 experienced mild and 6 experienced moderate pain. The average post-surgery pain score was significantly lower than the pre-surgery score (13.7 vs 2.5, <i>p</i> < 0.001). Multivariate analyses revealed that intravenous (IV) analgesics and preoperative endoscopic interventions were independent predictors of recurrent pain.</p><p><strong>Conclusions: </strong>The incidence of recurrent pain in CP patients post-surgery was 56.8%, with a significant reduction in pain intensity postoperatively. Patients who required preoperative IV analgesics and underwent endoscopic interventions demonstrated a higher risk of recurrent pain. Neuropathic pain was not identified as a cause of pain recurrence in this study.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizing tumor factors for mortality and survival outcomes following liver resection in Indonesia's hepatocellular carcinoma patients.","authors":"Lam Sihardo, Arnetta Naomi Louise Lalisang, Ridho Ardhi Syaiful, Afid Brilliana Putra, Yarman Mazni, Agi Satria Putranto, Toar Jean Maurice Lalisang","doi":"10.14701/ahbps.24-179","DOIUrl":"10.14701/ahbps.24-179","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The 3-year mortality rate for hepatocellular carcinoma (HCC) in Indonesia was 94.4%. This underscores a significant health issue in Southeast Asia, particularly in Indonesia due to its large population. This study aimed to characterize the outcomes of liver resection for HCC at a National Referral Center in Indonesia.</p><p><strong>Methods: </strong>Between 2010 and 2020, all patients with HCC undergoing liver resection were included as subjects. Variables collected included sex, age, hepatitis status, and tumor's characteristics. Mortality and survival were the primary outcomes of the study.</p><p><strong>Results: </strong>Among seventy patients, the mortality rate was 71.4%, with a median overall survival of 19.0 months (95% confidence interval [95%CI]: 6.831.2). Thirty-one patients (44.3%) had extra-large HCC tumors (> 10 cm). Those with extra-large tumors had a lower median survival of 8.0 months. Child-Pugh B and Edmonson-Steiner grade 4 were associated with an increased mortality risk, with unadjusted hazard ratios (HRs) of 2.2 (95%CI: 1.14.3, <i>p</i> = 0.026) and 3.2 (95%CI: 1.37.7, <i>p</i> = 0.011), respectively. Multivariate analysis indicated that Child-Pugh class B significantly increased the risk of mortality, with an adjusted HR of 2.3 (95%CI: 1.05.2, <i>p</i> = 0.046).</p><p><strong>Conclusions: </strong>While surgical resection is feasible for tumors of any size, most clinical features are not statistically significantly associated with survival outcomes. The prevalence of extra-large tumors among Indonesian HCC patients highlights the importance of early diagnosis and intervention. Surgical intervention at an earlier stage and with better grade tumors could potentially enhance survival outcomes.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"11-20"},"PeriodicalIF":1.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of soft pancreas on pancreaticoduodenectomy outcomes and the development of the preoperative soft pancreas risk score.","authors":"Zofia Czarnecka, Kevin Verhoeff, David Bigam, Khaled Dajani, James Shapiro, Blaire Anderson","doi":"10.14701/ahbps.24-172","DOIUrl":"10.14701/ahbps.24-172","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Pancreatic texture is difficult to predict without palpation. Soft pancreatic texture is associated with increased post-operative complications, including postoperative pancreatic fistula (POPF), cardiac, and respiratory complications. We aimed to develop a calculator predicting pancreatic texture using patient factors and to illustrate complications from soft pancreatic texture following pancreaticoduodenectomy.</p><p><strong>Methods: </strong>Data was collected from the 2016 to 2021 American College of Surgeons National Surgical Quality Improvement database including 17,706 pancreaticoduodenectomy cases. Patients were categorized into two cohorts based on pancreatic texture (9,686 hard, 8,020 soft). Multivariable modeling assessed the impact of patient factors on complications, mortality, and pancreatic texture. These preoperative factors were integrated into a risk calculator (preoperative soft pancreas risk score [PSPRS]) that predicts pancreatic texture.</p><p><strong>Results: </strong>Patients with a soft pancreas had higher rates of postoperative complications compared to those with a hard pancreas (56.5% vs 42.2%; <i>p</i> < 0.001), particularly a threefold increase in POPF rate, and at least a twofold increase in rates of acute kidney injury, deep organ space infection, septic shock, and prolonged length of stay. Female sex (odds ratio [OR]: 1.14, confidence interval [CI]: 1.06-1.22, <i>p</i> < 0.001) and higher body mass index (OR: 1.12, CI: 1.09-1.16, <i>p</i> < 0.001) were independently associated with a soft pancreas. PSPRS ≥6 correctly identified >40% of patients preoperatively as having a hard pancreas (68.9% specificity).</p><p><strong>Conclusions: </strong>A soft pancreas was independently associated with serious postoperative complications. Our results were integrated into a risk calculator predicting pancreatic texture from preoperative patient factors, potentially enhancing preoperative counseling and surgical decision-making.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"62-71"},"PeriodicalIF":1.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}