Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.
University of Paris Cité, Paris, France.
Surg Endosc. 2023 Jan;37(1):544-555. doi: 10.1007/s00464-022-09527-w. Epub 2022 Aug 24.
Risk factors for postoperative pancreatic fistula (POPF) following pancreatic enucleation by the open approach (OpenEN) are well known. However, ENs are more frequently performed laparoscopically (LapEN). The aim of this study was to analyze the risk factors of POPF following LapEN.
All patients in our prospective database who underwent LapEN were evaluated. We report the demographics, surgical, early and long-term outcomes. Numerous variables were analyzed to identify the risk factors of POPF.
From 2008 to 2020, 650 laparoscopic pancreatic resections were performed including 64 EN (10%). The median age was 51 years old (17-79), median BMI was 24 (19-48), and 44 patients were women (69%). The main presentation was an incidental diagnosis (n = 40; 62%), pain (n= 10;16%), and hypoglycemia (n = 8;12%). The main indications were neuroendocrine tumors (40; 63%), mucinous cystadenomas (15; 23%), intraductal papillary mucinous neoplasie (3; 5%), and other benign cysts (6; 9%). Lesions were located on the distal pancreas (43; 67%), head (n = 17; 27%), and neck (4; 6%). The median size was 20 mm (9-110); 30 mm (20-110) for mucinous cystadenoma and 18 mm (8-33) for NET. The median operative time was 90 mn (30-330), median blood loss was 20 ml (0-800) ml, and there were no transfusions and one conversion. There were no mortalities and overall morbidity (n = 22; 34%) included grades B and C POPF (10;16%) and post-pancreatectomy hemorrhage (4; 6%). The median hospital stay was 7 days (3-42). There were no invaded lymph nodes and all cystic lesions were nonmalignant. After a mean follow-up of 24 months, there was no recurrence. The risk factors for grades B/C POPF were mucinous cystadenoma and proximity to the Wirsung duct < 3 mm.
In this series, the outcome of LapEN was excellent with no mortality and a low rate of morbidity. However, the risk of POPF is increased with cystic lesions and those close to the Wirsung duct.
经开放手术（OpenEN）行胰腺剜除术后发生胰瘘（POPF）的风险因素众所周知。然而，剜除术（ENs）越来越多地通过腹腔镜（LapEN）进行。本研究旨在分析 LapEN 后发生 POPF 的风险因素。
对我们前瞻性数据库中接受 LapEN 的所有患者进行评估。我们报告了人口统计学、手术、早期和长期结果。分析了许多变量以确定 POPF 的风险因素。
2008 年至 2020 年，共进行了 650 例腹腔镜胰腺切除术，其中 64 例行胰腺 EN（10%）。中位年龄为 51 岁（17-79），中位 BMI 为 24（19-48），44 例为女性（69%）。主要表现为偶然诊断（n=40；62%）、疼痛（n=10；16%）和低血糖（n=8；12%）。主要适应证为神经内分泌肿瘤（n=40；63%）、黏液性囊腺瘤（n=15；23%）、导管内乳头状黏液性肿瘤（n=3；5%）和其他良性囊肿（n=6；9%）。病变位于胰腺远端（n=43；67%）、头部（n=17；27%）和颈部（n=4；6%）。中位肿瘤大小为 20mm（9-110）；30mm（20-110）用于黏液性囊腺瘤，18mm（8-33）用于神经内分泌肿瘤。中位手术时间为 90 分钟（30-330），中位失血量为 20ml（0-800）ml，无输血和 1 例中转开腹。无死亡，总并发症发生率（n=22；34%）包括 B 级和 C 级 POPF（n=10；16%）和胰周出血（n=4；6%）。中位住院时间为 7 天（3-42）。无淋巴结侵犯，所有囊性病变均为良性。平均随访 24 个月后，无复发。B/C 级 POPF 的危险因素为黏液性囊腺瘤和靠近胰管＜3mm。
在本系列中，LapEN 的结果良好，无死亡，并发症发生率低。然而，囊性病变和靠近胰管的病变会增加 POPF 的风险。
Zotero 插件