Madeka Isheeta, Yi Steven, Evans Julia, Baek David, Naringrekar Haresh V, Lavu Harish, Yeo Charles J, Nevler Avinoam, Bowne Wilbur B
Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University Hospital, 132 South 10, Philadelphia, PA, 19107, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
World J Surg Oncol. 2025 Jul 22;23(1):293. doi: 10.1186/s12957-025-03920-0.
Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk factors associated with post-operative pancreatic fistulas (POPF) after pancreatic enucleation.
A two-tiered retrospective study was conducted. We identified 423 patients from TriNetX, and 34 patients from a single-institution IRB-approved database who underwent pancreatic enucleation between 2004-2025 and 2012-2023, respectively. Univariate and multivariate analyses were performed to determine risk factors associated with post-operative complications and occurrence of POPFs.
In the TriNetX cohort, 128 (30.3%) experienced postoperative complications after pancreatic enucleation. On univariate analysis, hyperlipidemia (HLD) (OR = 2.37), gastroesophageal reflux disease (GERD) (OR = 3.87), acute pancreatitis (OR = 8.28), chronic pancreatitis (OR = 4.76), nicotine dependence (OR = 2.36), ascites (OR = 6.49), deep vein thrombosis (DVT), pulmonary embolism (PE), and thrombophlebitis (OR = 2.95), and body mass index (BMI) ≥ 25 (OR = 1.56) were identified as significant risk factors. On multivariate analysis, acute pancreatitis (HR = 1.64), chronic pancreatitis (HR = 1.78), ascites (HR = 2.96), DVT, PE and thrombophlebitis (HR = 1.74) remained significant. In our single-institution enucleation cohort, 8 patients had a POPF (23.5%). The measured distance from the neoplasm to the main pancreatic duct (MPD) was significantly shorter in patients who developed POPF (2.8 vs 6.5 mm, P < 0.05). ROC analysis determined that shorter distance from the MPD was predictive of POPF occurrence (AUC = 0.79, p < 0.005). Increased estimated blood loss was also associated with POPF (p < 0.01).
Our study identifies clinicopathologic risk factors associated with post-operative complications and POPF after pancreatic enucleation. The distance from the neoplasm to the MPD appears to be a key component of decision-making in the development of POPF.
胰腺摘除术是一种用于高度选择性胰腺肿瘤患者的保留实质的手术。我们旨在利用多机构健康研究网络平台（TriNetX）和一个高容量单一中心，评估胰腺摘除术后的并发症，并确定与术后胰瘘（POPF）相关的风险因素。
进行了一项分层回顾性研究。我们分别从TriNetX中确定了423例患者，以及从一个经机构审查委员会批准的单一机构数据库中确定了34例在2004年至2025年和2012年至2023年期间接受胰腺摘除术的患者。进行单因素和多因素分析以确定与术后并发症和POPF发生相关的风险因素。
在TriNetX队列中，128例（30.3%）患者在胰腺摘除术后出现术后并发症。单因素分析显示，高脂血症（HLD）（OR = 2.37）、胃食管反流病（GERD）（OR = 3.87）、急性胰腺炎（OR = 8.28）、慢性胰腺炎（OR = 4.76）、尼古丁依赖（OR = 2.36）、腹水（OR = 6.49）、深静脉血栓形成（DVT）、肺栓塞（PE）和血栓性静脉炎（OR = 2.95）以及体重指数（BMI）≥25（OR = 1.56）被确定为显著风险因素。多因素分析显示，急性胰腺炎（HR = 1.64）、慢性胰腺炎（HR = 1.78）、腹水（HR = 2.96）、DVT、PE和血栓性静脉炎（HR = 1.74）仍然显著。在我们的单一机构摘除术队列中，8例患者发生了POPF（23.5%）。发生POPF的患者中，肿瘤到主胰管（MPD）的测量距离显著更短（2.8 vs 6.5 mm，P < 0.05）。ROC分析确定MPD距离较短可预测POPF的发生（AUC = 0.79，p < 0.005）。估计失血量增加也与POPF相关（p < 0.01）。
我们研究确定了胰腺摘除术后与术后并发症和POPF相关的临床病理风险因素。肿瘤到MPD的距离似乎是POPF发生决策中的关键因素。
