Optimizing prediction models for pancreatic fistula after pancreatectomy:Current status and future perspectives

Postoperative pancreatic fistula(POPF)is a frequent complication after pancre-atectomy,leading to increased morbidity and mortality.Optimizing prediction models for POPF has emerged as a critical focus in surgical research.Although over sixty models following pancreaticoduodenectomy,predominantly reliant on a variety of clinical,surgical,and radiological parameters,have been documented,their predictive accuracy remains suboptimal in external validation and across diverse populations.As models after distal pancreatectomy continue to be pro-gressively reported,their external validation is eagerly anticipated.Conversely,POPF prediction after central pancreatectomy is in its nascent stage,warranting urgent need for further development and validation.The potential of machine learning and big data analytics offers promising prospects for enhancing the accuracy of prediction models by incorporating an extensive array of variables and optimizing algorithm performance.Moreover,there is potential for the development of personalized prediction models based on patient-or pancreas-specific factors and postoperative serum or drain fluid biomarkers to improve accuracy in identifying individuals at risk of POPF.In the future,prospective multicenter studies and the integration of novel imaging technologies,such as artificial intelligence-based radiomics,may further refine predictive models.Addressing these issues is anticipated to revolutionize risk stratification,clinical decision-making,and postoperative management in patients undergoing pancre-atectomy.

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

Ligamentum teres hepatis patch enhances the healing of pancreatic fistula after distal pancreatectomy

Pancreatic fistula is one of the most common complications after the distal pancreatectomy.Many methods have been tried to solve the problem,but no one is optimal,especially for the soft pancreatic stump cases.This study used ligamentum teres hepatis as a patch to cover the pancreatic stump.Between October 2010 and December 2012,seventyseven patients who had undergone distal pancreatectomy with a soft pancreatic stump were divided into two groups:group A(n=39,patients received conventional ligated main pancreatic duct method)and group B(n=38,patients underwent a coverage procedure).Patients in group A had a longer recovery from postoperative pancreatic fistula than those in group B(16.4±3.5 vs 10.8±1.6 days,P【0.05).The coverage procedure with ligamentum teres hepatis is a safe,effective and convenient method for patients with a soft pancreas remnant during distal pancreatectomy.

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.

Elderly patients had more severe postoperative complications after pancreatic resection:A retrospective analysis of 727 patients

AIM To examine the impact of aging on the short-term outcomes following pancreatic resection(PR) in elderly patients.METHODS A retrospective cohort study using prospectively collected data was conducted at the China National Cancer Center. Consecutive patients who underwent PR from January 2004 to December 2015 were identifiedand included. ‘Elderly patient' was defined as ones age 65 and above. Comorbidities, clinicopathology, perioperative variables, and postoperative morbidity and mortality were compared between the elderly and young patients. Univariate and multivariate analyses were performed using the Cox proportional hazard model for severe postoperative complications(grades Ⅲb-Ⅴ).RESULTS A total of 454(63.4%) patients were < 65-yearsold and 273(36.6%) patients were ≥ 65-yearsold, respectively. Compared to patients < 65-yearsold, elderly patients had worse American Society of Anesthesiologists scores(P = 0.007) and more comorbidities(62.6% vs 32.4%, P < 0.001). Elderly patients had more severe postoperative complications(16.8% vs 9.0%, P = 0.002) and higher postoperative mortality rates(5.5% vs 0.9%, P < 0.001). In the multivariate Cox proportional hazards model for severe postoperative complications, age ≥ 65 years [hazard ratio(HR) = 1.63; 95% confidence interval(CI): 1.18-6.30], body mass index ≥ 24 kg/m^2(HR = 1.20, 95%CI: 1.07-5.89), pancreaticoduodenectomy(HR = 4.86, 95%CI: 1.20-8.31) and length of operation ≥ 241 min(HR = 2.97; 95%CI: 1.04-6.14) were significant(P = 0.010, P = 0.041, P = 0.017 and P = 0.012, respectively).CONCLUSION We found that aging is an independent risk factor for severe postoperative complications after PR. Our results might contribute to more informed decision-making for elderly patients.

Is it sufficient to evaluate only preoperative systemic inflammatory biomarkers to predict postoperative complications after pancreaticoduodenectomy?

Postoperative morbidity and mortality rates are still very high among patients undergoing pancreaticoduodenectomy(PD).However,mortality rates secondary to morbidities that are detected early and well-managed postoperatively are lower among patients undergoing PD.Since early detection of complications plays a very important role in the management of these patients,many ongoing studies are being conducted on this subject.Recent endoscopic retrograde cholangiopancreatography and biliary drainage history of the patient study group is important for comparison of C-reactive protein(CRP),an inflammatory parameter evaluated in the retrospective study by Coppola et al published in the World Journal of Gastrointestinal Surgery and titled“Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy:Literature review and single center experience”.Therefore,it may be more appropriate to compare CRP values in randomized patients.

Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports

BACKGROUND Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess.This refractory complication can be fatal;therefore,intensive treatment is important.Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis,and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL.We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.CASE SUMMARY The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy,and pancreatic leakage was observed postoperatively.Intractable pancreatic fistula led to intraperitoneal abscess,and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8.The abscess resolved after 7 d of CLL.The second patient underwent distal pancreatectomy.Pancreatic leakage was observed,and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump.CLL was instituted from POD 9,and the abscess resolved after 4 d of CLL.The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma.Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula;however,intraperitoneal abscess was detected on POD 59.We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult.CLL was instituted from POD 63,and the abscess resolved after 1 wk of CLL.CONCLUSION CLL has therapeutic potential for postoperative pancreatic fistula.

Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy

AIM: To establish a scoring system to predict clinicallyrelevant postoperative pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD).METHODS: The clinical records of 921 consecutive patients who underwent PD between 2008 and 2013 were reviewed retrospectively. Postoperative pancreatic fistula(POPF) was defined and classified by the international study group of pancreatic fistula(ISGPF).We used a logistic regression model to determine the independent risk factors of CR-POPF and developed a scoring system based on the regression coefficient of the logistic regression model. The optimal cut-off value to divide the risk strata was determined by the Youden index. The patients were divided into two groups(low risk and high risk). The independent sample t test was used to detect differences in the means of drain amylase on postoperative day(POD) 1, 2 and 3. The optimal cut-off level of the drain amylase to distinguish CR-POPF from non-clinical POPF in the two risk strata groups was determined using the receiver operating characteristic(ROC) curves.RESULTS: Grade A POPF occurred in 106(11.5%)patients, grade B occurred in 57(6.2%) patients,and grade C occurred in 32(3.5%) patients. A predictive scoring system for CR-POPF(0-6 points) was constructed using the following four factors: 1 point for each body mass index ≥ 28 [odds ratio(OR) = 3.86;95% confidence interval(CI): 1.92-7.75, P = 0.00],soft gland texture(OR = 4.50; 95%CI, 2.53-7.98, P =0.00), and the difference between the blood loss and transfusion in operation ≥ 800 mL(OR = 3.45; 95%CI,1.92-7.75, P = 0.00); and from 0 points for a 5 mm or greater duct diameter to 3 points for a less than 2 mm duct(OR = 8.97; 95%CI: 3.70-21.77, P = 0.00). The ROC curve showed that the area under the curve of this score was 0.812. A score of 3 points was suggested to be the best cut-off value(Youden index = 0.485). In the low risk group, a drain amylase level ≥ 3600 U/L on POD3 could distinguish CR-POPF from non-clinicalPOPF(the sensitivity and specificity were 75% and85%, respectively). In the high risk group, the best cutoff was a drain amylase level of 1600(the sensitivity and specificity were 77 and 63%, respectively).CONCLUSION: A 6-point scoring system accurately predicted the occurrence of CR-POPF. In addition, a drain amylase level on POD3 might be a predictor of this complication.

Comparison of outcomes with stapler versus hand-sewn closure of the pancreatic stump following minimally invasive distal pancreatectomy:a retrospective cohort study

Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remains unclear.Methods:Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected.The outcomes of MDP with stapler and hand-sewn closure were compared.The primary outcome was clinically relevant postoperative pancreatic fistula(CR-POPF)per the International Study Group of Pancreatic Surgery definition.Results:Of the 384 patients(stapler closure,339;hand-sewn closure,45)enrolled,249 developed CR-POPF(grades B and C:242 and 7 patients,respectively).The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group(64.6%and 1.5%vs 51.1%and 4.4%,P=.078 and P=.223,respectively).No differences between the stapler and hand-sewn groups were observed regarding the median operation time(207 vs 222 minutes,P=.139),incidence of major complications(16.5%vs 20.0%,P=.559),and mortality(0.2%vs 0%,P=1.000).The independent risk factors of CR-POPF were abdominal abscess,prolonged operation time,and transection site(P=.004,.006,and.001,respectively).Conclusion:The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort.Randomized controlled trials are needed to verify this finding.

Laparoscopic distal pancreatectomy is as safe and feasible as open procedure:A meta-analysis

AIM:To evaluate the feasibility and safety of laparoscopic distal pancreatectomy(LDP) compared with open distal pancreatectomy(ODP).METHODS:Meta-analysis was performed using the databases,including PubMed,the Cochrane Central Register of Controlled Trials,Web of Science and BIOSIS Previews.Articles should contain quantitative data of the comparison of LDP and ODP.Each article was reviewed by two authors.Indices of operative time,spleen-preserving rate,time to fluid intake,ratio of malignant tumors,postoperative hospital stay,incidence rate of pancreatic fistula and overall morbidity rate were analyzed.RESULTS:Nine articles with 1341 patients who underwent pancreatectomy met the inclusion criteria.LDP was performed in 501(37.4%) patients,while ODP was performed in 840(62.6%) patients.There were significant differences in the operative time,time to fluid intake,postoperative hospital stay and spleen-preserving rate between LDP and ODP.There was no difference between the two groups in pancreatic fistula rate [random effects model,risk ratio(RR) 0.996(0.663,1.494),P = 0.983,I2 = 28.4%] and overall morbidity rate [random effects model,RR 0.81(0.596,1.101),P = 0.178,I2 = 55.6%].CONCLUSION:LDP has the advantages of shorter hospital stay and operative time,more rapid recovery and higher spleen-preserving rate as compared with ODP.

Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy

BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR)= 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.

Perioperative management of distal pancreatectomy

Recent advances in surgical techniques and perioperative management have markedly reduced operative morbidity after distal pancreatectomy(DP).However,some questions remain regarding the protocol for the perioperative management of DP,in particular,with regard to the development of pancreatic fistula(PF).A review of DP was therefore conducted in order to standardize the management of patients for a favorable outcome.Overall,operative technique and perioperative management emerged as two critical factors contributing to favorable outcome in DP patients.As for the operative method,surgical and closure techniques exhibited differences in outcome.Laparoscopic DP generally yields more favorable perioperative outcomes compared to open DP,and is applicable for benign tumors and some ductal carcinomas of the pancreas.Robotic DP is also available for safe pancreatic surgery.En bloc celiac axis resection offers a high R0 resection rate and potentially allows for some local control in the case of advanced pancreatic cancer.Following resection,staple closure was not found to reduce the rate of PF when compared to hand-sewn closure.In addition,ultrasonic dissection devices,fibrin glue sealing,and staple closure with mesh reinforcement were shown to significantly reduce PF,although there was some bias in these studies.In perioperative management,both preoperative and postoperative treatment affected outcome.First,preoperative endoscopic pancreatic stenting may be an effective prophylactic measure against fistula development following DP in selected patients.Second,in postoperative management,a multifactorial approach including prophylactic antibiotics improved high surgical site infection rates following complex hepato-pancreatobiliary surgery.Furthermore,although conflicting results have been reported,somatostatin analogues should be administered selectively to patients considered to have a high risk for PF.Finally,careful drain management also facilitates a favorable outcome in patients with PF after DP.The results of the review indicate that laparoscopic DP coupled with perioperative management influences outcome in DP patients.

Impact of body mass index on complications following pancreatectomy:Ten-year experience at National Cancer Center in China

AIM: To examine the impact of body mass index(BMI)on outcomes following pancreatic resection in the Chinese population.METHODS: A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Individuals who underwent pancreatic resection between January2004 and December 2013 were identified and included in the study. Persons were classified as having a normal weight if their BMI was < 24 kg/m2 and overweight/obese if their BMI was ≥ 24 kg/m2 as defined by the International Life Sciences Institute Focal Point in China. A χ 2 test(for categorical variables) or a t test(for continuous variables) was used to examine the differences in patients' characteristics between normal weight and overweight/obese groups. Multiple logistic regression models were used to assess the associationsof postoperative complications, operative difficulty,length of hospital stay, and cost with BMI, adjusting for age, sex, and type of surgery procedures.RESULTS: A total of 362 consecutive patients with data available for BMI calculation underwent pancreatic resection for benign or malignant disease from January1, 2004 to December 31, 2013. Of the 362 patients,156 were overweight or obese and 206 were of normal weight. One or more postoperative complications occurred in 35.4% of the patients following pancreatic resection. Among patients who were overweight or obese, 42.9% experienced one or more complications,significantly higher than normal weight(29.6%)individuals(P = 0.0086). Compared with individuals who had normal weight, those with a BMI ≥ 24.0kg/m2 had higher delayed gastric emptying(19.9% vs5.8%, P < 0.0001) and bile leak(7.7% vs 1.9%, P =0.0068). There were no significant differences seen in pancreatic fistula, gastrointestinal hemorrhage, reoperation,readmission, or other complications. BMI did not show a significant association with intraoperative blood loss, operative time, length of hospital stay, or cost.CONCLUSION: Higher BMI increases the risk for postoperative complications after pancreatectomy in the Chinese population. The findings require replication in future studies with larger sample sizes.

Arguments for an individualized closure of the pancreatic remnant after distal pancreatic resection

AIM:To analyze risk factors for postoperative pancreatic fistula(POPF) rate after distal pancreatic resection(DPR).METHODS:We performed a retrospective analysis of 126 DPRs during 16 years.The primary endpoint was clinically relevant pancreatic fistula.RESULTS:Over the years,there was an increasing rate of operations in patients with a high-risk pancreas and a significant change in operative techniques.POPF was the most prominent factor for perioperative morbidity.Significant risk factors for pancreatic fistula were high body mass index(BMI) [odds ratio(OR) = 1.2(CI:1.1-1.3),P = 0.001],high-risk pancreatic pathology [OR = 3.0(CI:1.3-7.0),P = 0.011] and direct closure of the pancreas by hand suture [OR = 2.9(CI:1.2-6.7),P = 0.014].Of these,BMI and hand suture closure were independent risk factors in multivariate analysis.While hand suture closure was a risk factor in the low-risk pancreas subgroup,high BMI further increased the fistula rate for a high-risk pancreas.CONCLUSION:We propose a risk-adapted and indication-adapted choice of the closure method for the pancreatic remnant to reduce pancreatic fistula rate.

Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy

The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.

Complications of modern pancreaticoduodenectomy:A systematic review and meta-analysis

Background:In the past decades,the perioperative management of patients undergoing pancreaticoduo-denectomy(PD)has undergone major changes worldwide.This review aimed to systematically determine the burden of complications of PD performed in the last 10 years.Data sources:A systematic review was conducted in PubMed for randomized controlled trials and ob-servational studies reporting postoperative complications in at least 100 PDs from January 2010 to April 2020.Risk of bias was assessed using the Cochrane RoB2 tool for randomized studies and the method-ological index for non-randomized studies(MINORS).Pooled complication rates were estimated using random-effects meta-analysis.Heterogeneity was investigated by subgroup analysis and meta-regression.Results:A total of 20 randomized and 49 observational studies reporting 63229 PDs were reviewed.Mean MINORS score showed a high risk of bias in non-randomized studies,while one quarter of the ran-domized studies were assessed to have high risk of bias.Pooled incidences of 30-day mortality,overall complications and serious complications were 1.7%(95%CI:0.9%-2.9%;I 2=95.4%),54.7%(95%CI:46.4%-62.8%;I 2=99.4%)and 25.5%(95%CI:21.8%-29.4%;I 2=92.9%),respectively.Clinically-relevant postopera-tive pancreatic fistula risk was 14.3%(95%CI:12.4%-16.3%;I 2=92.0%)and mean length of stay was 14.8 days(95%CI:13.6-16.1;I 2=99.3%).Meta-regression partially attributed the observed heterogeneity to the country of origin of the study,the study design and the American Society of Anesthesiologists class.Conclusions:Pooled complication rates estimated in this study may be used to counsel patients scheduled to undergo a PD and to set benchmarks against which centers can audit their practice.However,cautious interpretation is necessary due to substantial heterogeneity.

Traumatic pancreatic fistula with sinistral portal hypertension:Surgical management

Combined ductal and vascular injuries are awesome complications of pancreatic injury.We report on a 29-year-old male unrestrained driver who sustained a blunt abdominal injury from the steering wheel in a high velocity head-on car collision.He developed a pancreatic fistula,portosplenic venous thrombosis and sinistral portal hypertension as a result of complete duct disruption at the pancreatic neck.We describe a safe surgical strategy of spleen-preserving distal pancreatectomy after failed medical and endoscopic management.

Preoperative diabetes as a protective factor for pancreatic fistula after pancreaticoduodenectomy: a meta-analysis

BACKGROUND： The role of diabetes mellitus （DM） in pancreatic fistula （PF） or clinical relevant PF （CR-PF） after pancreaticoduodenectomy （PD） or pylorus-preserving pancreaticoduodenectomy （PPPD） is unclear. We conducted a meta-analysis to investigate the relationship between DM and PF or CR-PF.DATA SOURCES： Embase, MEDLINE and Cochrane databases were searched systematically for relevant articles from January 2005 to June 2013. The selected studies that examined clinical risk factors of PF or CR-PF were included. We created pooled estimates for our outcomes using the random-effects model. RESULTS： Sixteen observational clinical studies were included. Pooling of PF rates from ten studies revealed that DM was associated with a decreased risk of PF （P=0.01）. CR-PF rates from 8 studies showed no significant difference between DM and control group （P=0.14）. CONCLUSIONS： DM is not a risk factor for PF in patients undergoing PD or PPPD. On the contrary, patients without DM are at a higher risk of PF because the pancreases in these patients have more fatty tissue and the pancreas is soft.

Laparoscopic distal pancreatectomy: Up-to-date and literature review

Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.

胰十二指肠切除术后发生胃排空延迟的危险因素分析

目的探讨胰十二指肠切除(PD)术后发生胃排空延迟(DGE)的危险因素。方法对湖州市中心医院肝胆胰外科2021年6月至2023年11月期间行PD术治疗的102例患者的临床资料进行回顾性分析。采用单因素分析及多因素Logistic回归对导致DGE发生的危险因素进行分析。结果本组病例术后DGE发生率为45.10%(46/102),其中A级22例、B级14例、C级10例。DGE组(n=46)较无DGE组(n=56)术后住院时间明显延长[(25.7±9.5)d vs(16.2±3.9)d,P<0.001]。单因素分析显示,DGE发生与PD手术时间≥6 h及术后胰瘘(POPF)、腹腔出血、腹腔感染相关。多因素Logistic回归分析显示,POPF(A级,OR=6.280,95%CI 1.826-21.597,P=0.004;B级,OR=28.132,95%CI 2.800-282.611,P=0.005)为PD术后发生DGE的独立危险因素。Spearman秩分析显示,PD术后DGE等级与POPF等级呈正相关(r=0.569,P<0.001)。结论PD术后发生DGE主要与PD手术时间长及PD术后并发症相关。缩短PD手术时间、早期诊断并及时处理胰瘘、腹腔感染、腹腔出血等术后并发症可能有助于减少DGE发生率。