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Abstract：
OBJECTIVE: Post-operative pancreatic fistula (POPF) remains the main complication after distal pancreatectomy (DP). The aim of this study is to evaluate the potential benefit of different durations of progressive stapler closure on POPF rate and severity after DP.
METHODS: Patients who underwent DP between 2016 and 2023 were retrospectively enrolled and divided into two groups according to the duration of the stapler closure: those who underwent a progressive compression for < 10 min and those for ≥ 10 min.
RESULTS: Among 155 DPs, 83 (53.5%) patients underwent pre-firing compression for < 10 min and 72 (46.5%) for ≥ 10 min. As a whole, 101 (65.1%) developed POPF. A lower incidence rate was found in case of ≥ 10 min compression (34-47.2%) compared to < 10 min compression (67- 80.7%) (p = 0.001). When only clinically relevant (CR) POPFs were considered, a prolonged pre-firing compression led to a lower rate (15-20.8%) than the < 10 min cohort (32-38.6%; p = 0.02). At the multivariate analysis, a compression time of at least 10 min was confirmed as a protective factor for both POPF (OR: 5.47, 95% CI: 2.16-13.87; p = 0.04) and CR-POPF (OR: 2.5, 95% CI: 1.19-5.45; p = 0.04) development. In case of a thick pancreatic gland, a prolonged pancreatic compression for at least 10 min was significantly associated to a lower rate of CR-POPF compared to < 10 min (p = 0.04).
CONCLUSIONS: A prolonged pre-firing pancreatic compression for at least 10 min seems to significantly reduce the risk of CR-POPF development. Moreover, significant advantages are documented in case of a thick pancreatic gland.
METHODS: Patients who underwent DP between 2016 and 2023 were retrospectively enrolled and divided into two groups according to the duration of the stapler closure: those who underwent a progressive compression for < 10 min and those for ≥ 10 min.
RESULTS: Among 155 DPs, 83 (53.5%) patients underwent pre-firing compression for < 10 min and 72 (46.5%) for ≥ 10 min. As a whole, 101 (65.1%) developed POPF. A lower incidence rate was found in case of ≥ 10 min compression (34-47.2%) compared to < 10 min compression (67- 80.7%) (p = 0.001). When only clinically relevant (CR) POPFs were considered, a prolonged pre-firing compression led to a lower rate (15-20.8%) than the < 10 min cohort (32-38.6%; p = 0.02). At the multivariate analysis, a compression time of at least 10 min was confirmed as a protective factor for both POPF (OR: 5.47, 95% CI: 2.16-13.87; p = 0.04) and CR-POPF (OR: 2.5, 95% CI: 1.19-5.45; p = 0.04) development. In case of a thick pancreatic gland, a prolonged pancreatic compression for at least 10 min was significantly associated to a lower rate of CR-POPF compared to < 10 min (p = 0.04).
CONCLUSIONS: A prolonged pre-firing pancreatic compression for at least 10 min seems to significantly reduce the risk of CR-POPF development. Moreover, significant advantages are documented in case of a thick pancreatic gland.
摘要：
目的：胰体远端切除术（DP）后胰瘘（POPF）仍是术后的主要并发症。这项研究的目的是评估不同持续时间的渐进式吻合器闭合对DP后POPF率和严重程度的潜在益处。
方法：回顾性纳入2016年至2023年接受DP的患者，并根据吻合器闭合的持续时间分为两组：接受渐进性压迫<10分钟的患者和≥10分钟的患者。
结果：在155名DP中，83例（53.5％）患者进行了<10分钟的预发压迫，72例（46.5％）进行了≥10分钟。作为一个整体,101（65.1%）发展了POPF。与<10分钟压缩（67-80.7％）相比，≥10分钟压缩（34-47.2％）的发生率较低（p=0.001）。当仅考虑临床相关(CR)POPFs时，与<10分钟的队列(32-38.6%;p=0.02)相比,延长的预发压缩率(15-20.8%)较低。在多变量分析中，至少10分钟的压缩时间被证实是POPF(OR:5.47,95%CI:2.16-13.87;p=0.04)和CR-POPF(OR:2.5,95%CI:1.19-5.45;p=0.04)发展的保护因素.如果胰腺厚，与<10min相比,延长的胰腺压迫至少10min与较低的CR-POPF发生率显著相关(p=0.04).
结论：延长预放电胰腺压迫至少10分钟似乎可显著降低CR-POPF发生的风险。此外，显着的优势被记录在一个厚的胰腺的情况下。
方法：回顾性纳入2016年至2023年接受DP的患者，并根据吻合器闭合的持续时间分为两组：接受渐进性压迫<10分钟的患者和≥10分钟的患者。
结果：在155名DP中，83例（53.5％）患者进行了<10分钟的预发压迫，72例（46.5％）进行了≥10分钟。作为一个整体,101（65.1%）发展了POPF。与<10分钟压缩（67-80.7％）相比，≥10分钟压缩（34-47.2％）的发生率较低（p=0.001）。当仅考虑临床相关(CR)POPFs时，与<10分钟的队列(32-38.6%;p=0.02)相比,延长的预发压缩率(15-20.8%)较低。在多变量分析中，至少10分钟的压缩时间被证实是POPF(OR:5.47,95%CI:2.16-13.87;p=0.04)和CR-POPF(OR:2.5,95%CI:1.19-5.45;p=0.04)发展的保护因素.如果胰腺厚，与<10min相比,延长的胰腺压迫至少10min与较低的CR-POPF发生率显著相关(p=0.04).
结论：延长预放电胰腺压迫至少10分钟似乎可显著降低CR-POPF发生的风险。此外，显着的优势被记录在一个厚的胰腺的情况下。
