Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Endpoints
2.2. Definitions
2.3. Surgical Technique
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Unsuitability for pneumoperitoneum |
ASA score > III |
Body mass index (BMI) < 35 kg/m2 |
Borderline or Locally advanced tumours |
Intraperitoneal or extraperitoneal metastases |
Tumor size > 5 cm |
Patients who underwent total pancreatectomy |
Patients requiring concomitant organ or vascular resection |
Conversion to open |
Variables | PJ (n = 40) | PG (n = 20) | Overall (n = 60) | p Value |
---|---|---|---|---|
Age, years, median (IQR) | 63.2 (55.6–71.4) | 61.9 (53.8–68.5) | 62.9 (54.1–71.1) | 0.688 |
Sex, n (%) | ||||
| 27 (67.5%) | 13 (65%) | 40 (66.7%) | 0.627 |
| 13 (32.5%) | 7 (35%) | 20 (33.3%) | 0.799 |
BMI, Kg/m2, mean (±SD) | 25.1 ± 3.4 | 24.8 ± 2.8 | 25 ± 3.2 | 0.824 |
ASA score, mean (±SD) | 2.5 ± 0.06 | 2.2 ± 0.04 | 2.4 ± 0.7 | 0.856 |
Pathology | ||||
| 30 (75%) | 15 (75%) | 45 (75%) | 1 |
| 21 | 8 | 29 | |
| 3 | 2 | 5 | |
| 2 | 2 | 4 | |
| 2 | 2 | 4 | |
| 1 | 1 | 2 | |
| 1 | / | 1 | |
| 10 (25%) | 5 (25%) | 15 (25%) | 1 |
| 4 | 2 | 6 | |
| 3 | 1 | 4 | |
| 2 | 1 | 3 | |
| 1 | 1 | 2 | |
Tumor size, cm, mean (±SD) | 2.86 ± 1.7 | 2.55 ± 1.4 | 2.8 ± 1.6 | 0.822 |
Neoadjuvant CHT, n (%) | 6 (15%) | 2 (10%) | 8 (13.3%) | 0.479 |
Pancreatic texture, n (%) | 1 | |||
| 16 (40%) | 8 (40%) | 24 (40%) | |
| 24 (60%) | 12 (60%) | 36 (60%) | |
Wirsung duct diameter, median ± SD | 3.4 ± 2.4 | 2.9 ± 2.5 | 3.2 ± 2.4 | 0.627 |
| 31 (77.5%) | 14 (70%) | 45 (75%) | 0.669 |
| 9 (22.5%) | 6 (30%) | 15 (25%) | 0.611 |
ISGPS classification | ||||
| 19 (47.5%) | 9 (45%) | 28 (46.7%) | 0.821 |
| 5 (12.5%) | 3 (15%) | 8 (13.3%) | 0.793 |
| 12 (30%) | 5 (25%) | 17 (28.3%) | 0.645 |
| 4 (10%) | 3 (15%) | 7 (11.7%) | 0.612 |
Mean CRS-POPF ± SD | 4.6 ± 2.2 | 5.1 ± 1.8 | 4.7 ± 2.1 | 0.433 |
Histopathology, n (%) | ||||
| 8 (20%) | 5 (25%) | 13 (21.7%) | 0.523 |
| 32 (80%) | 15 (75%) | 47 (78.3%) | |
Estimated blood loss | ||||
| 8 (20%) | 4 (20%) | 12 (20%) | 1 |
| 32 (80%) | 16 (80%) | 48 (80%) | |
Categories of POPF risk, n (%) | 0.788 | |||
| 6 (15%) | 2 (10%) | 8 (13.3%) | |
| 16 (40%) | 6 (30%) | 22 (%) | |
| 14 (35%) | 9 (45%) | 23 (35%) | |
| 4 (10%) | 3 (15%) | 7 (11.7%) |
Variables | PJ (n = 40) | PG (n = 20) | Overall (n = 60) | p Value |
---|---|---|---|---|
Operative time, min, median ± SD | 375 ± 102 | 315 ± 110 | 355 ± 103 | 0.345 |
Time of the anastomoses, min, median ± SD | 32 ± 11 | 25 ± 14 | 30.2 ± 12 | 0.002 |
Estimated blood loss, ml, median (IQR) | 270 (180–600) | 295 (200–700) | 275 (180–600) | 0.442 |
Intraoperative blood transfusion, n (%) | 3 (7.5%) | 1 (5%) | 4 (6.7%) | 0.766 |
Post-operative complications, n (%) | 19 (47.5%) | 9 (45%) | 28 (46.6%) | 0.635 |
| −11 (27.5%) | −6 (30%) | −17 (28.3%) | 0.826 |
| −8 (20%) | −3 (15%) | −11 (18.3%) | 0.542 |
| 5 (12.5%) | 3 (15%) | 8 (13.3%) | 0.524 |
CR-POPF | 5 (12.5%) | 2 (10%) | 7 (11.7%) | 0.827 |
| −3 (7.5%) | −1 (5%) | −4 (6.7%) | 0.789 |
| −2 (5%) | −1 (5%) | −3 (5%) | 0.977 |
Delayed gastric emptying, n (%) | 2 (5%) | 1 (5%) | 3 (5%) | 0.928 |
Grade C Postoperative hemorrhage, n (%) | 1 (2.5%) | 2 (10%) | 3 (5%) | 0.338 |
Pancreatitis, n (%) | 1 (2.5%) | / | 1 (1.4%) | 0.782 |
Bile leakage, n (%) | 1 (2.5%) | 1 (5%) | 2 (3.3%) | 0.654 |
Ascites, n (%) | 1 (2.5%) | / | 1 (1.4%) | 0.782 |
Intra-abdominal collection, n (%) | 3 (7.5%) | / | 3 (4.3%) | 0.002 |
Length of hospital stays, days, median ± SD | 14 ± 4 | 11 ± 6 | 15.8 ± 5 | 0.223 |
Readmission, n (%) | 4 (10%) | 1 (5%) | 5 (8.3%) | 0.524 |
Reoperation, n (%) | 2 (5%) | 1 (5%) | 3 (5%) | 0.928 |
Mortality 90-days, n (%) | 2 (5%) | 1 (5%) | 3 (5%) | 0.928 |
Variables | PJ (n = 20) | PG (n = 20) | p Value |
---|---|---|---|
Histopathology, n (%) | |||
- PDAC/IPMN | 14 (70%) | 15 (75%) | 0.855 |
- Ampullary, Duodenal, Cystic | 6 (30%) | 5 (25%) | 0.793 |
Pancreatic texture, n (%) | |||
- Soft | 13 (65%) | 13 (65%) | 1 |
- Hard | 7 (35%) | 7 (35%) | 1 |
Pancreatic duct diameter, mm, n (%) | |||
- ≥3 | 13 (65%) | 14 (70%) | 0.643 |
- <3 | 7 (35%) | 6 (30%) | 0.635 |
ISGPS Classification | |||
- A | 9 (45%) | 9 (45%) | 1 |
- B | 3 (15%) | 3 (15%) | 1 |
- C | 5 (25%) | 5 (25%) | 1 |
- D | 3 (15%) | 3 (15%) | 1 |
Intraoperative blood loss, mL, n (%) | |||
- ≥500 | 5 (25%) | 4 (20%) | 0.617 |
- <500 | 15 (75%) | 16 (80%) | 0.539 |
Median Operative time, min (IQR) | 330 (270.2–395.8) | 315 (265–382) | 0.75 |
Anastomotic time, min (IQR) | 46 (28–52) | 25 (18–40) | 0.002 |
Morbidity rate, n (%) | 11 (55%) | 9 (45%) | 0.721 |
- Minor | 5 (25%) | 6 (30%) | 0.586 |
- Major | 6 (30%) | 3 (15%) | 0.324 |
Biochemical Leak, n (%) | 4 (20%) | 3 (15%) | 0.721 |
CR–POPF, n (%) | 3 (15%) | 2 (10%) | 0.478 |
Delayed gastric emptying, n (%) | 1 (5%) | 1 (5%) | 1 |
Post-pancreatectomy hemorrhage, n (%) | / | 2 (10%) | 0.003 |
Intra-abdominal collection, n (%) | 3 (15%) | / | 0.002 |
Reoperation, n (%) | 2 (10%) | 1 (5%) | 0.474 |
Median length of hospital stays, days (IQR) | 14.2 (12.4–22) | 11.5 (9.5–19) | 0.165 |
Variables | CR-POPF (n = 7) | No-POPF (n = 53) | Univariate p Value | Odds Ratio | 95% CI |
---|---|---|---|---|---|
Age | |||||
| 4 | 27 | 0.76 | ||
| 3 | 26 | |||
Sex | |||||
| 4 | 36 | 0.57 | ||
| 3 | 17 | |||
BMI | |||||
| 5 | 14 | <0.05 | 6.96 | (1.2–40.1) |
| 2 | 39 | |||
Diabetes | |||||
| 1 | 10 | 0.77 | ||
| 6 | 43 | |||
ASA score | |||||
| 3 | 29 | 0.55 | ||
| 4 | 24 | |||
Pancreatic duct diameter | |||||
| 2 | 43 | |||
| 5 | 10 | <0.05 | 10.7 | (1.8–63.6) |
Underlying pathology | |||||
PDAC/IPMN/etc. | 4 | 43 | 0.16 | ||
Ampullary/Cystic/Duodenal | 3 | 10 | |||
Tumor size | |||||
| 2 | 21 | 0.59 | ||
| 5 | 33 | |||
Texture of the pancreas | |||||
| 6 | 18 | <0.05 | 11.66 | (1.3–104.4) |
| 1 | 35 | - | ||
Operative time | |||||
| 4 | 34 | 0.71 | ||
| 3 | 19 | |||
Blood loss | |||||
| 5 | 7 | <0.05 | 10.95 | (2.1–56.3) |
| 2 | 46 | - | ||
Reconstruction type | |||||
| 5 | 35 | 0.77 | ||
| 2 | 18 |
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Marino, M.V.; Heng Chiow, A.K.; Mirabella, A.; Vaccarella, G.; Komorowski, A.L. Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study. J. Clin. Med. 2021, 10, 2181. https://doi.org/10.3390/jcm10102181
Marino MV, Heng Chiow AK, Mirabella A, Vaccarella G, Komorowski AL. Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study. Journal of Clinical Medicine. 2021; 10(10):2181. https://doi.org/10.3390/jcm10102181
Chicago/Turabian StyleMarino, Marco V., Adrian Kah Heng Chiow, Antonello Mirabella, Gianpaolo Vaccarella, and Andrzej L. Komorowski. 2021. "Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study" Journal of Clinical Medicine 10, no. 10: 2181. https://doi.org/10.3390/jcm10102181