Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Liu, Qu; Zhao, Zhiming; Gao, Yu; Zhao, Guodong; Tan, Xiaojie; Wang, Chihyuan; Liu, Rong

doi:10.1002/jhbp.682

Cited by 33 publications

(18 citation statements)

References 33 publications

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“…A total of 37 studies 10,11,[28][29][30]33,34,37,39,44,45,[48][49][50][51][52][53]55,[58][59][60][61][62][63][64]72,74,75,77,81,83,87,87,[123][124][125] with 14,471 patients investigated MPD diameter as a risk factor for CR-POPF, applying different cut-offs. Irrespective of the cut-off, duct diameter was associated with CR-POPF (OR 3.14, 95% CI 2.53-3.90, P < 0.01) (Fig.…”

Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

et al. 2021

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Objective: The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD). Summary Background Data: Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking. Methods: A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort. Results: Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62–5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively (P < 0.001). Conclusion: For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results.

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Section: Association Of Mpd Size and Popfmentioning

confidence: 99%

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

et al. 2021

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“…The detailed surgical procedures and lymphadenectomy have been described in our previous studies. 17,18 Patients were randomly assigned (in a 2:1 ratio) to either a training cohort or a validation cohort. This study was approved by the Ethics Committee of the PLA General Hospital, and written informed consent was obtained from all patients.…”

Section: Patients Selectionmentioning

confidence: 99%

A novel online calculator to predict recurrence risk in patients with distal cholangiocarcinoma after radical pancreaticoduodenectomy

Zhang

Zhao

et al. 2021

Journal of Surgical Oncology

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Background: Patients with distal cholangiocarcinoma (DCC) are prone to relapse even after radical pancreaticoduodenectomy. In this study, we sought to create an online nomogram calculator to accurately predict the recurrence risk of DCC. Methods: A total of 184 patients were included. Multivariate Cox regression analysis was used to identify independent prognosis factors for recurrence-free survival and overall survival. A nomogram was constructed according to the prognostic factors in the training cohort and then tested in the validation cohort. Results: Multivariate Cox analysis showed preoperative carbohydrate antigen 19-9 (p < 0.001), maximum tumor size (p = 0.076), perineural invasion (p = 0.044), and N stage (p = 0.076) were independent prognostic factors for DCC relapse. We then constructed a nomogram with these four factors. The consistency index (C-index) of the nomogram in the training and validation cohorts were 0.703 and 0.665, respectively. Time-dependent receiver operating characteristic and decision curve analyses revealed that the nomogram provided higher diagnostic power and net benefit compared with other staging systems. Conclusion:In this study, we developed an online nomogram calculator that can accurately predict the recurrence risk of DCC and identify patients with a high risk of recurrence in a simple and convenient manner.

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“…In a systematic review, the high POPF rate of 26.2% in patients with a soft pancreatic texture was independent of the type of PJ method used [16]. Other new PJ methods adopted to MIPD have also been proposed [40][41][42]. However, the studies were not limited to patients with a soft pancreatic texture and direct comparison with the present study is di cult.…”

Section: Reinforcement Of Water Tightness Of the Anastomosismentioning

confidence: 68%

Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture 

Kiguchi¹,

Sugioka²,

Nakauchi³

et al. 2020

Preprint

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Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.

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Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Cited by 33 publications

References 33 publications

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

A novel online calculator to predict recurrence risk in patients with distal cholangiocarcinoma after radical pancreaticoduodenectomy

Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture

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Novel single‐layer continuous suture of pancreaticojejunostomy for robotic pancreaticoduodenectomy

Cited by 33 publications

References 33 publications

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula

A novel online calculator to predict recurrence risk in patients with distal cholangiocarcinoma after radical pancreaticoduodenectomy

Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture&nbsp;

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Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture