Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Italy.
Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Italy.
Surgery. 2019 Sep;166(3):271-276. doi: 10.1016/j.surg.2019.02.016. Epub 2019 Apr 9.
Postoperative pancreatic fistula is the primary contributor to morbidity after distal pancreatectomy. To date, no techniques used for the transection and closure of the pancreatic stump have shown clear superiority over the others. This study aimed to compare the rate of postoperative pancreatic fistula after pancreatic transection conducted with a reinforced stapler versus an ultrasonic dissector after a distal pancreatectomy.
Prospectively collected data of consecutive patients who underwent distal pancreatectomy from 2014 to 2017 were reviewed retrospectively. We included distal pancreatectomies in which pancreatic transection was performed by reinforced stapler or ultrasonic dissector; we excluded extended distal pancreatectomies. To overcome the absence of randomization, we conducted a propensity matching analysis according to risk factors for postoperative pancreatic fistula.
Overall, 200 patients met the inclusion criteria. The reinforced stapler was employed in 108 patients and the ultrasonic dissector in 92 cases. After one-to-one propensity matching, 92 patients were selected from each group. The matched reinforced stapler and ultrasonic dissector cohort had no differences in baselines characteristics except for the mini-invasive approach, which was more common in the ultrasonic dissector group (34% vs 51%, P = .025). Overall, 48 patients (26%) developed a postoperative pancreatic fistula, 46 (25%) a grade B postoperative pancreatic fistula, and 2 (1%) a grade C postoperative pancreatic fistula. In the reinforced stapler group, the rate of postoperative pancreatic fistula was 12% (n = 11) and in the ultrasonic dissector group 40% (n = 37) with a P < .001.
The results of this study suggest that the use of reinforced stapler for pancreatic transection decreases the risk of postoperative pancreatic fistula. A randomized trial is required to confirm these preliminary data.
术后胰瘘是胰十二指肠切除术后发病率的主要原因。迄今为止，尚无一种用于胰腺残端横断和闭合的技术明显优于其他技术。本研究旨在比较使用加固吻合器与超声刀进行胰腺横断后远端胰腺切除术后胰瘘的发生率。
回顾性分析 2014 年至 2017 年连续接受远端胰腺切除术的患者的前瞻性收集数据。我们纳入了使用加固吻合器或超声刀进行胰腺横断的远端胰腺切除术；排除了扩大的远端胰腺切除术。为了克服缺乏随机化的问题，我们根据术后胰瘘的危险因素进行了倾向匹配分析。
共有 200 例患者符合纳入标准。108 例患者使用加固吻合器，92 例患者使用超声刀。在一对一倾向匹配后，每组选择 92 例患者。匹配的加固吻合器和超声刀组除微创方法外，其他基线特征无差异，超声刀组更为常见（34%比 51%，P =.025）。总体而言，48 例（26%）患者发生术后胰瘘，46 例（25%）为 B 级术后胰瘘，2 例（1%）为 C 级术后胰瘘。在加固吻合器组，术后胰瘘发生率为 12%（n = 11），在超声刀组为 40%（n = 37），P <.001。
本研究结果表明，使用加固吻合器进行胰腺横断可降低术后胰瘘的风险。需要进行随机试验来证实这些初步数据。
