TY - JOUR
T1 - Relationship between pancreatic thickness and staple height is relevant to the occurrence of pancreatic fistula after distal pancreatectomy
AU - Sugimoto, Motokazu
AU - Kendrick, Michael L.
AU - Farnell, Michael B.
AU - Nomura, Shogo
AU - Takahashi, Naoki
AU - Kobayashi, Tatsushi
AU - Kobayashi, Shin
AU - Takahashi, Shinichiro
AU - Konishi, Masaru
AU - Gotohda, Naoto
N1 - Funding Information:
This work was completed during the International Research Fellowship of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. We acknowledge and appreciate the foresight and efforts of the founders of the program - Professor Takada, Professor Kawarada, and the late Professor Hanyu from Japan and Professor Traverso, Professor Sarr, Professor Farnell, and Professor Reber from the USA. We also wish to express special thanks to the former director of the International Research Fellowship, Professor Sano, the current director, Professor Eguchi, and the previous directors plus members and office workers of the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Publisher Copyright:
© 2019 International Hepato-Pancreato-Biliary Association Inc.
PY - 2020/3
Y1 - 2020/3
N2 - Background: A triple-row stapler is widely used to divide the pancreas in distal pancreatectomy (DP). However, the selection criteria of the stapler cartridge to prevent postoperative pancreatic fistula (POPF) remain unclear. The objective of this study was to determine if factors concerning pancreatic thickness or staple size affect POPF after DP. Methods: Datasets of patients from the Mayo Clinic and National Cancer Center Hospital East who underwent DP using a triple-row stapler were merged. Risk of POPF was analyzed using clinicopathological variables, including data for pancreatic thickness and staple height. A compression index was defined as the designated staple height (mm) after closure divided by the pancreatic thickness (mm). Results: Among the 277 patients, POPF occurred in 65 (23%) patients. The median pancreatic thickness was 13.7 mm and the median compression index was 0.137. Multivariable logistic models showed that a greater pancreatic thickness (odds ratio, 1.190, P < 0.001) and a compression index ≤0.160 (odds ratio, 4.754, P < 0.001) were independently related with POPF. Conclusion: In patients undergoing DP using a triple-row stapler, the thickness of the pancreas was related with the occurrence of POPF. Selection of the stapler cartridge with a compression index of ≤0.160 may reduce the occurrence of POPF.
AB - Background: A triple-row stapler is widely used to divide the pancreas in distal pancreatectomy (DP). However, the selection criteria of the stapler cartridge to prevent postoperative pancreatic fistula (POPF) remain unclear. The objective of this study was to determine if factors concerning pancreatic thickness or staple size affect POPF after DP. Methods: Datasets of patients from the Mayo Clinic and National Cancer Center Hospital East who underwent DP using a triple-row stapler were merged. Risk of POPF was analyzed using clinicopathological variables, including data for pancreatic thickness and staple height. A compression index was defined as the designated staple height (mm) after closure divided by the pancreatic thickness (mm). Results: Among the 277 patients, POPF occurred in 65 (23%) patients. The median pancreatic thickness was 13.7 mm and the median compression index was 0.137. Multivariable logistic models showed that a greater pancreatic thickness (odds ratio, 1.190, P < 0.001) and a compression index ≤0.160 (odds ratio, 4.754, P < 0.001) were independently related with POPF. Conclusion: In patients undergoing DP using a triple-row stapler, the thickness of the pancreas was related with the occurrence of POPF. Selection of the stapler cartridge with a compression index of ≤0.160 may reduce the occurrence of POPF.
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U2 - 10.1016/j.hpb.2019.07.010
DO - 10.1016/j.hpb.2019.07.010
M3 - Article
C2 - 31416785
AN - SCOPUS:85070378745
SN - 1365-182X
VL - 22
SP - 398
EP - 404
JO - HPB
JF - HPB
IS - 3
ER -