Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
HPB (Oxford). 2021 Apr;23(4):633-640. doi: 10.1016/j.hpb.2020.09.004. Epub 2020 Oct 2.
Postoperative pancreatic fistula (POPF) is associated with potentially fatal complications, but there is lack of data on relationship between pancreas thickness, and stapler size and the POPF rate. This study aimed to suggest optimal stapler that reduces POPF rate according to the pancreas thickness.
This retrospective cohort study was conducted in two tertiary high-volume pancreas centers. 599 patients who underwent distal pancreatectomy were assessed for stump reinforcement methods, pathology findings, pancreas thickness, and cartridge used. The cartridges were grouped as I, II, III according to the closed height ≤1.5 mm, 1.8 mm, and ≥2.0 mm, respectively.
The POPF rate increased according to the thickness. The stapler Groups I, II, and III had an overall POPF rate of 66.4% vs. 61.7% vs. 57.8%, but Group II stapler cartridge showed a significant reduction in the POPF rate than other cartridges in pancreas with thickness <13 mm (53.5% vs. 21.7% vs. 36.0%, p = 0.031). There was no significant difference between the POPF rate according to stapler groups when the pancreas was thicker than 13 mm.
Thickness is the strongest risk factor in predicting POPF. Use of Group II stapler cartridge for pancreas with a thickness of <13 mm can help reduce POPF.
术后胰瘘（POPF）与潜在致命并发症相关，但目前缺乏关于胰腺厚度、吻合器尺寸与 POPF 发生率之间关系的数据。本研究旨在根据胰腺厚度建议可降低 POPF 发生率的最佳吻合器。
这是一项在两个三级大容量胰腺中心进行的回顾性队列研究。评估了 599 例行胰体尾切除术患者的残端加固方法、病理发现、胰腺厚度和使用的钉匣。根据闭合高度≤1.5mm、1.8mm 和≥2.0mm，将钉匣分为 I、II 和 III 组。
POPF 发生率随厚度增加而增加。厚度<13mm 时，各组的总体 POPF 发生率分别为 66.4%、61.7%和 57.8%，但 II 组钉匣在胰腺厚度<13mm 时显著降低了 POPF 发生率（53.5% vs. 21.7% vs. 36.0%，p=0.031）。当胰腺厚度>13mm 时，各组之间的 POPF 发生率无显著差异。
厚度是预测 POPF 的最强危险因素。在胰腺厚度<13mm 时使用 II 组钉匣有助于降低 POPF 发生率。
