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Acciuffi S, Hilal MA, Ferrari C, Al-Madhi S, Chouillard MA, Messaoudi N, Croner RS, Gumbs AA. Study International Multicentric Pancreatic Left Resections (SIMPLR): Does Surgical Approach Matter? Cancers (Basel) 2024; 16:1051. [PMID: 38473411 DOI: 10.3390/cancers16051051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Minimally invasive surgery is increasingly preferred for left-sided pancreatic resections. The SIMPLR study aims to compare open, laparoscopic, and robotic approaches using propensity score matching analysis. METHODS This study included 258 patients with tumors of the left side of the pancreas who underwent surgery between 2016 and 2020 at three high-volume centers. The patients were divided into three groups based on their surgical approach and matched in a 1:1 ratio. RESULTS The open group had significantly higher estimated blood loss (620 mL vs. 320 mL, p < 0.001), longer operative time (273 vs. 216 min, p = 0.003), and longer hospital stays (16.9 vs. 6.81 days, p < 0.001) compared to the laparoscopic group. There was no difference in lymph node yield or resection status. When comparing open and robotic groups, the robotic procedures yielded a higher number of lymph nodes (24.9 vs. 15.2, p = 0.011) without being significantly longer. The laparoscopic group had a shorter operative time (210 vs. 340 min, p < 0.001), shorter ICU stays (0.63 vs. 1.64 days, p < 0.001), and shorter hospital stays (6.61 vs. 11.8 days, p < 0.001) when compared to the robotic group. There was no difference in morbidity or mortality between the three techniques. CONCLUSION The laparoscopic approach exhibits short-term benefits. The three techniques are equivalent in terms of oncological safety, morbidity, and mortality.
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Affiliation(s)
- Sara Acciuffi
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Mohammed Abu Hilal
- Hepatobiliopancreatic, Robotic and Minimally Invasive Surgery Unit, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati 57, 25124 Brescia, Italy
| | - Clarissa Ferrari
- Research and Clinical Trials Office, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati 57, 25124 Brescia, Italy
| | - Sara Al-Madhi
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Marc-Anthony Chouillard
- Hepatobiliopancreatic Surgery, Université de Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France
| | - Nouredin Messaoudi
- Department of Hepatopancreatobiliary Surgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel and Europe Hospitals, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Roland S Croner
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Andrew A Gumbs
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- Department of Advanced & Minimally Invasive Surgery, American Hospital of Tbilisi, 17 Ushangi Chkheidze Street, Tbilisi 0102, Georgia
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Linder S, Holmberg M, Agopian-Dahlenmark L, Zhao H, Åkerström JH, Sparrelid E, Ghorbani P. Endoscopic main duct stenting in refractory postoperative pancreatic fistula after distal pancreatectomy - a friend or a foe? BMC Surg 2024; 24:33. [PMID: 38267861 PMCID: PMC10809585 DOI: 10.1186/s12893-023-02233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Clinically relevant (CR) postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) are common. Endoscopic treatment (ET) has only scarcely been explored. The aim of this study was to evaluate risk factors for CR POPF after DP and the efficacy of ET in adjunct to standard therapy. METHODS Consecutive patients without previous pancreatic surgery who underwent DP between 2011 and 2020 were evaluated, analyzing risk factors for CR POPF. The choice and performance of ET, main pancreatic duct (MPD) stenting, was not standardized. Healing time and complications after ET were registered. RESULTS 406 patients underwent DP, CR POPF occurred in 29.6%. ET was performed in 17 patients 27 days (median) after index surgery. Risk for CR POPF was increased in ASA-PS 1-2 patients, MPD ≤ 3 mm, procedure time ≥ 3 h, and CRP ≥ 180 on postoperative day 3. POPF resolved with standard treatment after 32 days and 59 days in the ET group (p < 0.001). There was one mortality in the ET-group (not procedure related). Mild post-ERCP pancreatitis occurred in three patients. CONCLUSIONS CR POPF is common after DP. Long operating time, a narrow MPD, low ASA score, and high postoperative CRP were risk factors for CR POPF. ET was not beneficial but proper evaluation was not possible due to few patients and non-standardized treatment. Complications after ET appeared mild.
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Affiliation(s)
- Stefan Linder
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- Karolinska University Hospital, Stockholm, Sweden.
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden
| | | | - Helena Zhao
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Hardvik Åkerström
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
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Sakamoto T, Kishino M, Murakami Y, Miyatani K, Shishido Y, Hanaki T, Matsunaga T, Yamamoto M, Tokuyasu N, Fujiwara Y. Surgical Outcomes of Robotic Distal Pancreatectomy Versus Laparoscopic Distal Pancreatectomy at a Hospital in a Sparsely Populated Area. Yonago Acta Med 2023; 66:375-379. [PMID: 37621978 PMCID: PMC10444586 DOI: 10.33160/yam.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
Background Robotic distal pancreatectomy (RDP) has a better or comparable surgical outcome when compared with laparoscopic distal pancreatectomy (LDP). However, whether the surgical outcome for these procedures in local, low-volume hospitals are comparable with those of the typically larger centers described in published reports remains unclear. Methods This study enrolled 48 patients who underwent either RDP or LDP between August 2012 and April 2023. Data were retrospectively analyzed to evaluate the short-term surgical outcomes of RDP versus LDP in our hospital, which is a low-volume center. Results The use of stapling with reinforcement in RDP was significantly higher than in LDP, and the postoperative hospital stay for RDP was significantly shorter than for LDP. Except for these two variables, there were no statistically significant differences between RDP and LDP in preoperative, intraoperative, or postoperative patient characteristics. Conclusion RDP can be performed as safely and effectively as LDP in a low-volume hospital located in a sparsely populated area.
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Affiliation(s)
- Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Mikiya Kishino
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuki Murakami
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Zhao Z, Zhou L, Han L, Zhou S, Tan Z, Dai R. The visceral pancreatic neck anterior distance may be an effective parameter to predict post-pancreaticoduodenectomy clinically relevant postoperative pancreatic fistula. Heliyon 2023; 9:e13660. [PMID: 36865459 PMCID: PMC9970899 DOI: 10.1016/j.heliyon.2023.e13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Background The clinically relevant postoperative pancreatic fistula (CR-POPF) is significantly correlated with a high post-pancreaticoduodenectomy (PD) mortality rate. Several studies have reported an association between visceral obesity and CR-POPF. Nevertheless, there are many technical difficulties and controversies in the measurement of visceral fat. The aim of this research was to determine whether the visceral pancreatic neck anterior distance (V-PNAD) was a credible predictor for CR-POPF. Methods We retrospectively analyzed the data of 216 patients who underwent PD in our center between January 2016 and August 2021. The correlation of patients' demographic information, imaging variables, and intraoperative data with CR-POPF was assessed. Furthermore, areas under the receiver operating characteristic curves for six distances (abdominal thickness, visceral thickness, abdominal width, visceral width, abdominal PNAD, V-PNAD) were used to identify the best imaging distance to predict POPF. Results In the multivariate logistic analysis, V-PNAD (P < 0.01) was the most significant risk factor for CR-POPF after PD. Males with a V-PNAD >3.97 cm or females with a V-PNAD >3.66 cm were included into the high-risk group. The high-risk group had a higher prevalence of CR-POPF (6.5% vs. 45.1%, P < 0.001), intraperitoneal infection (1.9% vs. 23.9%, P < 0.001), pulmonary infection (3.7% vs. 14.1%, P = 0.012), pleural effusion (17.8% vs. 33.8%, P = 0.014), and ascites (22.4% vs. 40.8%, P = 0.009) than the low-risk group. Conclusion Of all imaging distances, V-PNAD may be the most effective predictor of CR-POPF. Moreover, high-risk patients (males, V-PNAD >3.97 cm; females, V-PNAD >3.66 cm) have a high incidence of CR-POPF and poor short-term post-PD prognosis. Therefore, surgeons should perform PD carefully and take adequate preventive measures to reduce the incidence of pancreatic fistula when the patient has a high V-PNAD.
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Affiliation(s)
- Zhirong Zhao
- College of Medicine, Southwest Jiaotong University, Chengdu, China,General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Lichen Zhou
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China,College of Clinical Medicine Southwest Medical University, Luzhou, Sichuan Province, China
| | - Li Han
- College of Medicine, Southwest Jiaotong University, Chengdu, China,General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Shibo Zhou
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China,College of Clinical Medicine Southwest Medical University, Luzhou, Sichuan Province, China
| | - Zhen Tan
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Ruiwu Dai
- College of Medicine, Southwest Jiaotong University, Chengdu, China,General Surgery Center, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China,College of Clinical Medicine Southwest Medical University, Luzhou, Sichuan Province, China,Pancreatic Injury and Repair Key Laboratory of Sichuan Province, General Hospital of Western Theater Command, Chengdu, Sichuan Province, China,Corresponding author. Affiliated Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu 610031, Sichuan, China.
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A commentary on "Robotic distal pancreatectomy reduces pancreatic fistula in patients without visceral obesity as compared to open distal pancreatectomy: A propensity score matching retrospective cohort study". Int J Surg 2022; 104:106699. [PMID: 35717021 DOI: 10.1016/j.ijsu.2022.106699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
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Díaz-Vallejo JA, Rodríguez-Gutiérrez MM, Maestre DAV, Díaz-Rivera MC. A commentary on "Robotic distal pancreatectomy reduces pancreatic fistula in patients without visceral obesity as compared to open distal pancreatectomy: A propensity score matching retrospective cohort study" (Int J Surg 2021 Jun; 90:105960). Int J Surg 2021; 95:106066. [PMID: 34461342 DOI: 10.1016/j.ijsu.2021.106066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Jhony Alejandro Díaz-Vallejo
- Future Surgeons Chapter, Colombian Surgery Association, Calle 100 #14-63 Of.502, Bogotá, Colombia Facultad de Medicina, Universidad de Caldas, Manizales, Colombia Semillero de investigación en Ciencias Médicas y Quirúrgicas. Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, 660001, Pereira, Colombia
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