Background
n
| Head and uncinate together | POPF | Severe POPF | Risk factors | |
---|---|---|---|---|---|
Turrini et al. [16] | 7 | Yes | 43% | 14% | – |
Brient et al. [17] | 52 | Yes | 27% | 14% | Distance to MPD ≤ 2 mm |
Jilesen et al. [10] | 60 | Yes | – | 31% | Head/uncinate BMI |
Kaiser et al. [8] | 74 | Yes | 46% | 27% | – |
Faitot et al. [13] | 126 | Yes | 57% | 41% | Head/uncinate |
Song et al. [9] | 65 | Separated | 20% | 9% | Head/uncinate |
Strobel et al. [11] | 166 | Yes | 41% | 21% | Cystic morphology |
Wang et al. [6] | 142 | Yes | 53% | 16% | Age Acute pancreatitis Cystic morphology |
Zhang et al. [14] | 119 | Yes | 40% | 28% | NYHA class |
Present series | 47 | Separated | 49% | 32% | Lower head + uncinate |
Methods
Initial population
Initial staging and final selected population (Fig. 1)
Surgery
End-points studied
Statistical analyses
Results
Patient characteristics (Table 2)
n or median | % or range | |
---|---|---|
Male gender | 12 | 26% |
Age (years old) | 55 | 19–78 |
BMI (kg/m2) | 22.7 | 18–35.1 |
Pancreatic zones | ||
1 | 20 | 43% |
2 | 9 | 19% |
3 | 18 | 38% |
Distance to main duct (mm) | ||
≤ 2 mm | 21 | 45% |
> 2 mm | 26 | 55% |
Indication | ||
Neuroendocrine tumors | 20 | 43% |
Branch-duct IPMN | 17 | 36% |
Others | 18 | 21% |
Tumor morphology | ||
Cystic | 25 | 53% |
Solid | 22 | 47% |
Tumor size (mm) | 20 | 4–61 |
Operative duration (min) | 180 | 90–400 |
POPF | ||
Grade A | 8 | 17% |
Grades B and C | 15 | 33% |
Total | 23 | 50% |
Delay surgery—POPF | 7 | 4–26 |
Hemorrhage | 4 | 8.5% |
Reintervention | 5 | 11% |
Dindo morbidity | ||
Grades 3–4 | 16 | 34% |
Overall | 29 | 62% |
Perioperative transfusion | 4 | 8.5% |
Length of hospital stay (days) | 15 | 6–90 |
Readmission | 3 | 6.4% |
Surgery and postoperative course (Table 2)
Pancreatic fistula and risk factors (Table 3a and b)
a) | POPF (n = 23)% | No POPF (n = 24)% | Univariate P value | Odd ratio [95% CI] | Multivariate P value |
Gender | – | – | |||
Male | 8 (35) | 4 (17) | .19 | ||
Female | 15 (65) | 20 (83) | |||
Age (years old) | 52 | 56 | .39 | – | – |
BMI (kg/m2) | 24.6 | 22 .7 | .17 | – | – |
Pancreatic zones | .03 | 2.03 [1.01–4.07] | .048 | ||
1 | 8 (35) | 12 (50) | |||
2 | 2 (9) | 7 (29) | |||
3 | 13 (56) | 5 (21) | |||
Distance to main duct (mm) | – | – | |||
≤ 2 mm | 10 (44) | 11 (46) | 1 | ||
> 2 mm | 13 (46) | 13 (54) | |||
Tumor morphology | 1 | – | – | ||
Cystic | 13 (47) | 12 (50) | |||
Solid | 10 (44) | 12 (50) | |||
Tumor size (mm) | 24 | 22 | .55 | – | – |
Laparoscopic approach | 5 (22) | 6 (25) | 1 | – | – |
Operative duration (min) | 205 | 180 | .26 | – | – |
b) | POPF B/C (n = 15)% | No POPF B/C (n = 32)% | Univariate P value | Odd ratio [95% CI] | Multivariate P value |
Gender | .16 | – | – | ||
Male | 6 (40) | 6 (19) | |||
Female | 9 (60) | 26 (81) | |||
Age (years old) | 54 | 53 | .85 | – | – |
BMI (kg/m2) | 24.6 | 23.1 | .32 | – | – |
Pancreatic zones | .02 | 2.06 [1.01–4.3] | .05 | ||
1 | 3 (20) | 17 (53) | |||
2 | 2 (13) | 7 (22) | |||
3 | 10 (67) | 8 (25) | |||
Distance to main duct (mm) | .15 | ||||
≤ 2 mm | 9 (60) | 12 (38) | – | – | |
> 2 mm | 6 (40) | 20 (62) | |||
Tumor morphology | .99 | ||||
Cystic | 8 (53) | 17 (53) | – | – | |
Solid | 7 (47) | 15 (47) | |||
Tumor size (mm) | 22 | 22 | .98 | – | – |
Laparoscopic approach | 2 (13) | 9 (28) | .27 | – | – |
Operative duration (min) | 200 | 190 | .53 | – | – |
Pancreatic zones of enucleation (Table 4)
Zone #1 | Zone #2 | P value zone#1 vs zone #2 | Zone #3 | P value zone#1 + 2 vs zone #3 | |
---|---|---|---|---|---|
Tumor located in the corresponding zone but patient underwent standard pancreatectomy according to intraoperative decision (%)* | 1 (5) | 5 (36) | .027 | 1 (5) | ns |
n (%) | 20 (43) | 9 (19) | – | 18 (38) | – |
Male gender (%) | 3 (15) | 1 (11) | ns | 2 (11) | ns |
Age (years old) | 53 | 52 | ns | 56 | ns |
BMI (kg/m2) | 22.8 | 21.5 | ns | 25.4 | ns |
Distance to Wirsung (mm) | |||||
< 2 mm (%) | 7 (35) | 4 (44) | ns | 10 (56) | ns |
> 2 mm (%) | 13 (65) | 5 (56) | ns | 8 (44) | ns |
Tumor morphology | |||||
Cystic (%) | 10 (50) | 5 (56) | ns | 10 (56) | ns |
Solid (%) | 10 (50) | 4 (44) | ns | 8 (44) | ns |
Tumor size (mm) | 22 | 25 | ns | 22 | ns |
Laparoscopic approach | 8 (40) | 2 (22) | ns | 1 (6) | .03 |
Operative duration (min) | 170 | 180 | ns | 220 | .016 |
POPF | |||||
Grade A (%) | 5 (25) | 0 | ns | 3 (17) | ns |
Grades B and C (%) | 3 (15) | 2 (22) | ns | 10 (56) | .01 |
Total (%) | 8 (40) | 2 (22) | ns | 13 (72) | .017 |
Hemorrhage (%) | 0 | 1 (11) | ns | 3 (17) | ns |
Reintervention (%) | 0 | 1 (11) | ns | 4 (22) | ns |
DINDO morbidity | |||||
Grades 3–4 (%) | 3 (15) | 5 (56) | ns | 8 (44) | ns |
Overall (%) | 8 (40) | 5 (56) | ns | 16 (89) | ns |
Perioperative transfusion (%) | 0 | 0 | ns | 4 (22.2) | ns |
Length of hospital stay (days) | 13 | 15 | 23 | .04 | |
Readmission (%) | 0 | 0 | ns | 3 (17) | ns |