Short‐term outcomes and risk factors for pancreatic fistula after pancreatic enucleation: A single‐center experience of 142 patients

Wang, Xing; Tan, Chunlu; Zhang, Hao; Chen, Yonghua; Ke, Nengwen; Liu, Xu-Bao

doi:10.1002/jso.24804

Cited by 22 publications

(10 citation statements)

References 35 publications

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“…Furthermore, sensitivity analysis of high-volume studies (more than 20 enucleations and more than 4 per year) showed that in specialised centres, pancreatic enucleations can be performed with no increased risk of POPF. Enucleation has also been shown to have excellent short and long-term oncologic outcomes, with no increased risk of tumour recurrence 1112. This may be partly explained by the fact that most tumours resected by enucleation were benign or had low malignant potential to begin with.…”

Section: Discussionmentioning

confidence: 99%

Minimally-invasive versus open enucleation for pancreatic tumours: A propensity-score adjusted analysis

Kabir

Tan

Syn

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims This study aims to evaluate the perioperative outcomes of minimally-invasive enucleation (MIEn) of the pancreas versus open enucleation (OEn). Methods This is a retrospective review of 20 consecutive patients who underwent pancreatic enucleation at a single institution. Results Seven patients underwent MIEn, of which 3 were robotic and 4 were laparoscopic. After propensity-adjusted analysis, the only significant difference was a reduced rate of readmissions within 30 days in the MIEn group versus the OEn group [0 vs 4 (30.8%), p =0.0464]. There were no conversions to open in the MIEn group, and median operation time was similar in both groups. There was no difference in median EBL in both groups, and none of the patients in our series required blood transfusions. The overall morbidity rate was 45.0% and the major complication (Clavien-Dindo>2) rate was 15%; which was similar between both groups. Seven (35%) patients had a Grade B/C POPF, and there was no significant difference between the two groups for this. The MIEn group had a shorter median length of stay compared to OEn [5 days (range, 3–24) vs 8.5 days (range, 5–42)] this was not significant on propensity-adjusted analysis ( p =0.3195). There was no post-operative 90-day/in-hospital mortality in all 20 patients. Conclusions Our experience demonstrates that MIEn was associated with similar perioperative outcomes and fewer readmissions compared to OEn.

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Section: Discussionmentioning

confidence: 99%

Minimally-invasive versus open enucleation for pancreatic tumours: A propensity-score adjusted analysis

Kabir

Tan

Syn

et al. 2019

Ann Hepatobiliary Pancreat Surg

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“…In several published studies, pancreatic enucleation has shown to have good oncologic outcomes, with no increased risk of tumour recurrence. 15,16 In a meta-analysis of 22 retrospective studies, Huẗtner FJ et al showed how pancreatic enucleation is associated with reduced rates of pancreatic insufficiency, as well as shorter surgery time, lower blood loss, and shorter hospital stay. 17 This is because most of the tumours resected by enucleation were benign or had low malignant potential.…”

Section: Resultsmentioning

confidence: 99%

Case‐matched analysis of robotic versus open surgical enucleation for pancreatic tumours: A comparative cost‐effectiveness study

Caruso

Vicente

Quijano

et al. 2022

Robotics Computer Surgery

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Background: Enucleation has widely spread as an alternative strategy in the treatment of small pancreatic tumours and cystic lesions. To date there are limited data on perioperative outcomes after pancreatic enucleation performed using a minimally invasive robotic technique, particularly regarding the risk factors associated with postoperative pancreatic fistula (POPF). We perform a comparative study of robotic pancreatic enucleation (RPE) and open enucleation (OPE) with the aim of evaluating clinical and cost-effective outcomes. Methods: This is a case-matched analysis of patients who underwent robotic and open pancreatic enucleation performed at

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“…Consequently, the patient must be informed that EN is a “mini invasive” pancreatic procedure with the advantage of preserving pancreatic parenchyma but without a reduced risk of POPF and its associated morbidity. The risk factors of overall and severe POPF have already been studied: on the one hand, several factors, such as age [ 6 ], body mass index [ 10 ], distance to the main pancreatic duct [ 17 ], history of acute pancreatitis [ 6 ], and New York Heart Association class [ 14 ], were independently identified by a single publication each (Table 1 ); on the other hand, cystic morphology [ 6 , 11 ] and tumor location [ 9 , 10 , 13 ] were identified in at least two independent series (Table 1 ). Our study confirmed that tumor location (i.e., the corresponding EN area) was relevant to predict POPF, but we improved the precision of this result by delimiting a particular zone with a higher risk than the rest of the pancreatic parenchyma.…”

Section: Discussionmentioning

confidence: 99%

“…Parenchyma-sparing pancreatectomies were proposed as an alternative to standard pancreatectomy for noninvasive tumors to avoid pancreatic endocrine and exocrine insufficiencies [ 1 – 4 ]. In this manner, enucleation (EN) was first performed in the 1960s [ 5 ]; currently, neuroendocrine tumors (particularly insulinoma) and branch-duct intraductal papillary mucinous neoplasms (IPMNs) are the more frequent tumors resected by EN [ 6 – 15 ]. As EN induces parenchyma incision and, occasionally, deep pancreas opening, it exposes patients to postoperative pancreatic fistula (POPF) by unknown main pancreatic duct injury or weakening, especially if thermo-coagulation has been used too closely.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, several reports have shown that EN leads to the same or a higher rate of POPF than does standard pancreatectomy, but with a “toward zero” mortality [ 4 , 7 , 10 , 12 , 15 – 17 ]. Predictive factors of POPF after EN have already been reported, such as age [ 6 ], body mass index [ 10 ], distance from the main pancreatic duct (≤ 2 mm) [ 17 ], cystic morphology [ 6 ], history of acute pancreatitis [ 6 ], and New York Heart Association class [ 14 ] (Table 1 ). These factors are not a contraindication for EN but could help pancreatic surgeons inform patients about possible prolonged postoperative courses, counterbalanced by the very low risk of developing diabetes mellitus and/or steatorrhea [ 1 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

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A pancreatic zone at higher risk of fistula after enucleation

et al. 2018

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BackgroundTo determine predictive factors of postoperative pancreatic fistula (POPF) in patients undergoing enucleation (EN).MethodsFrom 2005 to 2017, 47 patients underwent EN and had magnetic resonance imaging available for precise analysis of tumor location. Three pancreatic zones were delimited by the right side of the portal vein and the main pancreatic head duct (zone #3 comprising the lower head parenchyma and the uncinate process).ResultsThe mortality and morbidity rates were 0% and 62%, respectively. POPF occurred in 23 patients (49%) and was graded as B or C (severe) in 15 patients (32%). Four patients (8.5%) developed a postoperative hemorrhage, and 5 patients (11%) needed a reintervention. In univariate and multivariate analyses, the pancreatic zone was the unique predictive factor of overall (P = .048) or severe POPF (P = .05). We did not observe any difference in postoperative courses when comparing the EN achieved in zones #1 and #2. We noted a longer operative duration (P = .016), higher overall (P = .017) and severe POPF (P = .01) rates, and longer hospital stays (P = .04) when comparing the EN achieved in zone #3 versus that in zones #1 and #2. Patients who underwent EN in zone #3 had a relative risk of developing a severe POPF of 3.22 compared with patients who underwent EN in the two other pancreatic zones.ConclusionOur study identifies the lower head parenchyma and the uncinate process as a high-risk zone of severe POPF after EN. Patients with planned EN in this zone could be selected and benefit from preoperative and/or intraoperative techniques to reduce the severe POPF rate.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1476-5) contains supplementary material, which is available to authorized users.

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Short‐term outcomes and risk factors for pancreatic fistula after pancreatic enucleation: A single‐center experience of 142 patients

Cited by 22 publications

References 35 publications

Minimally-invasive versus open enucleation for pancreatic tumours: A propensity-score adjusted analysis

Minimally-invasive versus open enucleation for pancreatic tumours: A propensity-score adjusted analysis

Case‐matched analysis of robotic versus open surgical enucleation for pancreatic tumours: A comparative cost‐effectiveness study

A pancreatic zone at higher risk of fistula after enucleation

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