Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy

Heijde, Nicky van der; Lof, Sanne; Busch, Olivier R.; Hingh, Ignace de; Kleine, Ruben H de; Molenaar, I. Quintus; Mungroop, Timothy H.; Stommel, Martijn W J; Besselink, Marc G.; Eijck, Casper van

doi:10.1016/j.surg.2021.11.009

Cited by 14 publications

(6 citation statements)

References 30 publications

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“…This suggests that the impact of the increased risk of POPF in MIDP is small. Previous studies have indeed suggested that POPF after MIDP is associated with less additional radiological drainage and shorter length of drainage 38 . The increased rate of interventions over time in the present study (7.9% to 17.8%) is probably related to the implementation of the algorithm used in the PORSCH trial since 2018, 39 which lowered the threshold for radiological drainage but also lead to a decrease in ICU admissions after MIDP over time (12.4% to 4.6%), which demonstrates that timely recognition of complications such as POPF may improve patient outcome.…”

Section: Discussionmentioning

confidence: 89%

Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

et al. 2023

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Objective: To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial. Background: Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking. Methods: Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome. Results: Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% (P < 0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers (P < 0.001). In the late implementation period, 5/16 centers performed > 75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P = 0.001), pancreatic cancer (24.2% vs. 45.9%, P < 0.001), vascular involvement (4.6% vs. 21.9%, P < 0.001), and multivisceral involvement (10.5% vs. 25.3%, P < 0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P < 0.001) and less blood loss (median 150 vs. 500 mL, P < 0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P = 0.008) occurred as compared to ODP. Conclusion: A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.

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Section: Discussionmentioning

confidence: 89%

Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

et al. 2023

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“…The risk of POPF is the major impacting complication after open and laparoscopic DP and is highly related to prolonged intra-abdominal drainage, hemorrhage, readmissions, sepsis and certainly mortality[ 87 , 88 ]. Older studies reported a higher rate (39%) of POPF after minimally invasive DP compared to open DP[ 89 ], but others failed to find significant differences after careful statistical patient stratification and homogenization[ 90 ]. Moreover, in 2021, a new POPF risk score (ua-FRS) was validated for minimally invasive pancreatic surgery[ 91 ], with a reported global incidence rate of 21%.…”

Section: Laparoscopic Dpmentioning

confidence: 99%

Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy

Bencini¹,

Minuzzo²

2023

World J Gastrointest Surg

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Because distal pancreatectomy (DP) has no reconstructive steps and less frequent vascular involvement, it is thought to be the easier counterpart of pancreaticoduodenectomy. This procedure has a high surgical risk and the overall incidences of perioperative morbidity (mainly pancreatic fistula), and mortality are still high, in addition to the challenges that accompany delayed access to adjuvant therapies (if any) and prolonged impairment of daily activities. Moreover, surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes. From this perspective, new surgical approaches, and aggressive techniques, such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection, could lead to improved survival in those affected by more locally advanced tumors. Conversely, minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress. The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications, length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy. Because a dedicated multidisciplinary team is crucial to pancreatic surgery, hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign, borderline, and malignant diseases of the pancreas. The purpose of this review is to examine the state of the art in distal pancreatectomies, with a special focus on minimally invasive approaches and oncological-directed techniques. The widespread reproducibility, cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.

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“…Postoperative pancreatic fistula (POPF) is a severe complication caused by pancreatoenteric anastomotic leakage, that occurs in about 10-30% of patients undergoing pancreatic head resection for surgical treatment of pancreatic cancer [112][113][114][115][116][117][118].…”

Section: Post-operative Pancreatic Fistulamentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma: Update of CT-Based Radiomics Applications in the Pre-Surgical Prediction of the Risk of Post-Operative Fistula, Resectability Status and Prognosis

Pacella,

Brunese,

D’Imperio

et al. 2023

JCM

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Background: Pancreatic ductal adenocarcinoma (PDAC) is the seventh leading cause of cancer-related deaths worldwide. Surgical resection is the main driver to improving survival in resectable tumors, while neoadjuvant treatment based on chemotherapy (and radiotherapy) is the best option-treatment for a non-primally resectable disease. CT-based imaging has a central role in detecting, staging, and managing PDAC. As several authors have proposed radiomics for risk stratification in patients undergoing surgery for PADC, in this narrative review, we have explored the actual fields of interest of radiomics tools in PDAC built on pre-surgical imaging and clinical variables, to obtain more objective and reliable predictors. Methods: The PubMed database was searched for papers published in the English language no earlier than January 2018. Results: We found 301 studies, and 11 satisfied our research criteria. Of those included, four were on resectability status prediction, three on preoperative pancreatic fistula (POPF) prediction, and four on survival prediction. Most of the studies were retrospective. Conclusions: It is possible to conclude that many performing models have been developed to get predictive information in pre-surgical evaluation. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice.

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Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy

Cited by 14 publications

References 30 publications

Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy

Pancreatic Ductal Adenocarcinoma: Update of CT-Based Radiomics Applications in the Pre-Surgical Prediction of the Risk of Post-Operative Fistula, Resectability Status and Prognosis

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