Department of Digestive Surgery and Transplantation, University Hospital Center, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
Department of Radiology, University Hospital Center, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
Int J Surg. 2019 May;65:128-133. doi: 10.1016/j.ijsu.2019.03.020. Epub 2019 Apr 5.
Several studies have suggested that the level of pancreatic division during distal pancreatectomy (DP) has an impact on postoperative pancreatic fistula (POPF) occurrence. The purpose of this study was thus to investigate the level of pancreatic division as a potential risk factor for POPF after DP for non-pancreatic ductal adenocarcinoma lesions (non-PDAC) in the era of parenchyma-sparing resection.
Data from 217 patients requiring DP were collected in a prospectively maintained database from January 1997 to December 2017 and analyzed retrospectively. Only data from patients who underwent DP using a linear stapler for non-PDAC lesions were analyzed. The outcomes of DP with body/tail division (Body-Tail group) were compared to DP with neck division (Neck group). The primary outcome was POPF according to the 2016 ISGPF.
Data from 157 patients who underwent DP using a linear stapler for non-PDAC lesions were included for analysis. Body-Tail (n = 53) and Neck (n = 104) groups were comparable concerning demographic data, period of treatment, BMI, ASA score, comorbidities, type of lesion, median lesion size, laparoscopic or open approach and spleen preservation rate. No differences were found in POPF (5.5 and 12.5%, p = 0.388) and new-onset pancreatogenic diabetes mellitus (22.5 vs. 20%; p = 0.439) in Body-Tail and Neck groups respectively.
Clinically relevant POPF and postoperative diabetes do not appear to be affected by pancreatic division level. The intention to prevent POPF or pancreatogenic diabetes should not influence the decision on level of pancreatic division during DP.
多项研究表明，远端胰腺切除术（DP）过程中的胰腺切断水平对术后胰瘘（POPF）的发生有影响。因此，本研究旨在探讨在保留实质的切除时代，DP 时胰腺切断水平作为非胰腺导管腺癌病变（非 PDAC）术后 POPF 的潜在危险因素。
从 1997 年 1 月至 2017 年 12 月，前瞻性地收集了 217 例需要 DP 的患者的数据，并进行了回顾性分析。仅分析了使用线性吻合器进行非 PDAC 病变 DP 的患者的数据。将体尾部（Body-Tail 组）和颈部（Neck 组）的 DP 结果进行比较。主要结局为根据 2016 ISGPF 定义的 POPF。
纳入了 157 例使用线性吻合器进行非 PDAC 病变 DP 的患者进行分析。Body-Tail（n=53）和 Neck（n=104）组在人口统计学数据、治疗期间、BMI、ASA 评分、合并症、病变类型、中位病变大小、腹腔镜或开放入路和脾保留率方面具有可比性。两组在 POPF（5.5%和 12.5%，p=0.388）和新发胰源性糖尿病（22.5%和 20%，p=0.439）方面无差异。
临床相关的 POPF 和术后糖尿病似乎不受胰腺切断水平的影响。预防 POPF 或胰源性糖尿病的意图不应影响 DP 时胰腺切断水平的决策。
