Surgery · 2026
Transection level matters: A prospective study on pancreatic fistula risk after left pancreatectomy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Nepi Angelica, De Pastena Matteo, Lionetto Gabriella, Paiella Salvatore, Ingaglio Naomi, Casule Valeria, Tondato Susanna, Malleo Giuseppe, Salvia Roberto
Аннотация
BACKGROUND: Postoperative pancreatic fistula remains the main cause of morbidity after left pancreatectomy, but the impact of pancreatic transection level on postoperative outcomes remains debated.
METHODS: We retrospectively analyzed a prospectively maintained single-center database of consecutive patients undergoing left pancreatectomy for malignant, premalignant, or benign disease between 2016 and 2024. Transection level was classified as standard pancreatic body-tail resection, pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection, or pancreatic tail resection. The primary end point was clinically relevant postoperative pancreatic fistula. Secondary end points included postpancreatectomy fluid collections, organ/space surgical site infection, postpancreatectomy hemorrhage, major complications, mortality, and endocrine/exocrine insufficiency. Associations were assessed using multivariable logistic regression, propensity-score matching, sensitivity analyses, and concordance index comparison.
RESULTS: Among 971 patients, transection was pancreatic body-tail resection in 661 (68.1%), pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection in 116 (11.9%), and pancreatic tail resection in 194 (20.0%). Postoperative pancreatic fistula occurred in 205 patients (21.1%) and was more frequent after nonstandard transections (pancreatic body-tail resection, 17.3%; pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection, 31.9%; pancreatic tail resection, 27.8%; P < .001). In multivariable analysis, pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection (odds ratio, 1.87; 95% confidence interval, 1.05-3.28) and pancreatic tail resection (odds ratio, 2.07; 95% confidence interval, 1.19-3.58) were associated with postoperative pancreatic fistula versus pancreatic body-tail resection. The association persisted after propensity-score matching but was attenuated after adjustment for pancreatic thickness and stump management. Pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection was associated with postpancreatectomy hemorrhage, and both nonstandard transections were associated with organ/space surgical site infection.
CONCLUSION: Transection level was associated with postoperative pancreatic fistula, organ/space surgical site infection, and postpancreatectomy hemorrhage after left pancreatectomy, supporting its role as an intraoperative marker of anatomic and technical complexity.
METHODS: We retrospectively analyzed a prospectively maintained single-center database of consecutive patients undergoing left pancreatectomy for malignant, premalignant, or benign disease between 2016 and 2024. Transection level was classified as standard pancreatic body-tail resection, pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection, or pancreatic tail resection. The primary end point was clinically relevant postoperative pancreatic fistula. Secondary end points included postpancreatectomy fluid collections, organ/space surgical site infection, postpancreatectomy hemorrhage, major complications, mortality, and endocrine/exocrine insufficiency. Associations were assessed using multivariable logistic regression, propensity-score matching, sensitivity analyses, and concordance index comparison.
RESULTS: Among 971 patients, transection was pancreatic body-tail resection in 661 (68.1%), pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection in 116 (11.9%), and pancreatic tail resection in 194 (20.0%). Postoperative pancreatic fistula occurred in 205 patients (21.1%) and was more frequent after nonstandard transections (pancreatic body-tail resection, 17.3%; pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection, 31.9%; pancreatic tail resection, 27.8%; P < .001). In multivariable analysis, pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection (odds ratio, 1.87; 95% confidence interval, 1.05-3.28) and pancreatic tail resection (odds ratio, 2.07; 95% confidence interval, 1.19-3.58) were associated with postoperative pancreatic fistula versus pancreatic body-tail resection. The association persisted after propensity-score matching but was attenuated after adjustment for pancreatic thickness and stump management. Pancreatic neck-body-tail resection/extended pancreatic neck-body-tail resection was associated with postpancreatectomy hemorrhage, and both nonstandard transections were associated with organ/space surgical site infection.
CONCLUSION: Transection level was associated with postoperative pancreatic fistula, organ/space surgical site infection, and postpancreatectomy hemorrhage after left pancreatectomy, supporting its role as an intraoperative marker of anatomic and technical complexity.