Itamoto Kota, Hikage Makoto, Fujiya Keiichi, Kamiya Satoshi, Tanizawa Yutaka, Bando Etsuro, Terashima Masanori
Division of Gastric Surgery Shizuoka Cancer Center Shizuoka Japan.
Ann Gastroenterol Surg. 2021 Jul 14;5(6):785-793. doi: 10.1002/ags3.12488. eCollection 2021 Nov.
Pancreas compression during minimally invasive gastrectomy causes blunt injury to the pancreas and leads to postoperative complications. However, the extent of practical compression associated with the incidence of postoperative complications remains unknown. This study aimed to evaluate the impact of pancreas compression, particularly the duration of compression, on short-term outcomes in minimally invasive gastrectomy for gastric cancer.
This study included 178 patients who underwent laparoscopic or robotic gastrectomy at the Shizuoka Cancer Center in 2018. The total time of pancreas compression during gastrectomy was measured using video-reviews, and the correlation between the time and surgical outcomes was evaluated.
A duration of 3 min was selected as the cutoff value of pancreas compression time to predict high drain amylase concentration on postoperative day 1 (≥1000 U/L). The incidence of clinically relevant pancreatic fistula (1.5% vs 12.4%, = .011) and all postoperative complications (12.3% vs 30.1%, = .010) were significantly higher in the longer-compression group than in the shorter-compression group. The multivariable analysis identified longer compression as the only independent risk factor for postoperative complications.
More than a few minutes of pancreas compression during minimally invasive gastrectomy was associated with a higher incidence of postoperative complications.
微创胃切除术期间胰腺受压会导致胰腺钝性损伤并引发术后并发症。然而，与术后并发症发生率相关的实际受压程度尚不清楚。本研究旨在评估胰腺癌微创胃切除术中胰腺受压，尤其是受压持续时间对短期预后的影响。
本研究纳入了2018年在静冈癌症中心接受腹腔镜或机器人辅助胃切除术的178例患者。通过视频回顾测量胃切除术期间胰腺受压的总时间，并评估该时间与手术结果之间的相关性。
选择3分钟作为胰腺受压时间的临界值，以预测术后第1天引流淀粉酶浓度升高（≥1000 U/L）。较长受压时间组的临床相关胰瘘发生率（1.5% 对12.4%，P = 0.011）和所有术后并发症发生率（12.3% 对30.1%，P = 0.010）均显著高于较短受压时间组。多变量分析确定较长的受压时间是术后并发症的唯一独立危险因素。
微创胃切除术中胰腺受压超过几分钟与术后并发症发生率较高相关。
