Abstract：
OBJECTIVE: Although minimally invasive distal pancreatectomy (MIDP) has become a treatment option for benign and malignant pancreatic tumors, the safety and efficacy of reinforced staplers in MIDP remain controversial. The present study was performed to evaluate the safety of reinforced staplers in MIDP and identify the risk factors for postoperative pancreatic fistula (POPF) after MIDP with reinforced staplers.
METHODS: In total, 92 consecutive patients who underwent MIDP at NHO Kyushu Medical Center from July 2016 to August 2023 were enrolled in this retrospective study. In all patients, a reinforced black cartridge triple-row stapler (Covidien Japan, Tokyo, Japan) was used during MIDP. The primary endpoint was the incidence of clinically relevant POPF. The risk factors for POPF were evaluated using multivariate analysis.
RESULTS: Among the 92 patients, 74 underwent laparoscopic distal pancreatectomy and 18 underwent robot-assisted distal pancreatectomy. Clinically relevant POPF occurred in seven (7.6%) of 92 patients. The rate of severe complications (Clavien-Dindo grade ≥III) was 10.8%, and the mortality rate was 0%. The median postoperative hospital stay was 14 days. Multivariate logistic regression analysis showed that the independent risk factor for clinically relevant POPF after MIDP with a reinforced stapler was a body mass index of ≥22.6 kg/m2 (p=0.050, odds ratio=7.60).
CONCLUSIONS: This study confirmed the safety and efficacy of reinforced staplers for preventing POPF after MIDP. A high body mass index was the only risk factor for clinically relevant POPF after MIDP with a reinforced stapler.
METHODS: In total, 92 consecutive patients who underwent MIDP at NHO Kyushu Medical Center from July 2016 to August 2023 were enrolled in this retrospective study. In all patients, a reinforced black cartridge triple-row stapler (Covidien Japan, Tokyo, Japan) was used during MIDP. The primary endpoint was the incidence of clinically relevant POPF. The risk factors for POPF were evaluated using multivariate analysis.
RESULTS: Among the 92 patients, 74 underwent laparoscopic distal pancreatectomy and 18 underwent robot-assisted distal pancreatectomy. Clinically relevant POPF occurred in seven (7.6%) of 92 patients. The rate of severe complications (Clavien-Dindo grade ≥III) was 10.8%, and the mortality rate was 0%. The median postoperative hospital stay was 14 days. Multivariate logistic regression analysis showed that the independent risk factor for clinically relevant POPF after MIDP with a reinforced stapler was a body mass index of ≥22.6 kg/m2 (p=0.050, odds ratio=7.60).
CONCLUSIONS: This study confirmed the safety and efficacy of reinforced staplers for preventing POPF after MIDP. A high body mass index was the only risk factor for clinically relevant POPF after MIDP with a reinforced stapler.
摘要：
目的：尽管微创远端胰腺切除术（MIDP）已成为良恶性胰腺肿瘤的治疗选择，MIDP中强化订书机的安全性和有效性仍存在争议。本研究旨在评估MIDP中强化吻合器的安全性，并确定MIDP术后胰瘘（POPF）的危险因素。
方法：总共，本回顾性研究纳入了2016年7月至2023年8月在NHO九州医学中心接受MIDP的92例连续患者。在所有患者中，增强型黑色墨盒三排订书机(CovidienJapan，东京,日本）在MIDP期间使用。主要终点是临床相关POPF的发生率。使用多变量分析评估POPF的危险因素。
结果：在92例患者中，74例接受腹腔镜远端胰腺切除术，18例接受机器人辅助远端胰腺切除术。92例患者中有7例（7.6％）发生了临床相关的POPF。严重并发症（Clavien-Dindo等级≥III）的发生率为10.8％，死亡率为0%。术后中位住院时间为14天。多因素logistic回归分析显示，使用强化吻合器进行MIDP后发生临床相关POPF的独立危险因素是体重指数≥22.6kg/m2（p=0.050，比值比=7.60）。
结论：本研究证实了强化缝合器预防MIDP后POPF的安全性和有效性。高体重指数是使用增强吻合器进行MIDP后临床相关POPF的唯一危险因素。
方法：总共，本回顾性研究纳入了2016年7月至2023年8月在NHO九州医学中心接受MIDP的92例连续患者。在所有患者中，增强型黑色墨盒三排订书机(CovidienJapan，东京,日本）在MIDP期间使用。主要终点是临床相关POPF的发生率。使用多变量分析评估POPF的危险因素。
结果：在92例患者中，74例接受腹腔镜远端胰腺切除术，18例接受机器人辅助远端胰腺切除术。92例患者中有7例（7.6％）发生了临床相关的POPF。严重并发症（Clavien-Dindo等级≥III）的发生率为10.8％，死亡率为0%。术后中位住院时间为14天。多因素logistic回归分析显示，使用强化吻合器进行MIDP后发生临床相关POPF的独立危险因素是体重指数≥22.6kg/m2（p=0.050，比值比=7.60）。
结论：本研究证实了强化缝合器预防MIDP后POPF的安全性和有效性。高体重指数是使用增强吻合器进行MIDP后临床相关POPF的唯一危险因素。
