Abstract
BackgroundPrevious studies reported a higher rate of postoperative pancreatic fistula after minimally invasive distal pancreatectomy compared to open distal pancreatectomy. It is unknown whether the clinical impact of postoperative pancreatic fistula after minimally invasive distal pancreatectomy is comparable with that after open distal pancreatectomy. We aimed to compare not only the incidence of postoperative pancreatic fistula, but more importantly, also its clinical impact. MethodsThis is a post hoc analysis of a multicenter randomized trial investigating a possible beneficial impact of a fibrin patch on the rate of clinically relevant postoperative pancreatic fistula (International Study Group for Pancreatic Surgery grade B/C) after distal pancreatectomy. Primary outcomes of the current analysis are the incidence and clinical impact of postoperative pancreatic fistula after both minimally invasive distal pancreatectomy and open distal pancreatectomy. ResultsFrom October 2010 to August 2017, 252 patients undergoing distal pancreatectomy were randomized, and data of 247 patients were available for analysis: 87 minimally invasive distal pancreatectomy and 160 open distal pancreatectomies. The postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was significantly higher than that after open distal pancreatectomy (28.7% vs 16.9%, P = .029). More patients were discharged with an abdominal surgical drain after minimally invasive distal pancreatectomy compared to open distal pancreatectomy (30/87, 34.5% vs 26/160, 16.5%, P = .001). In patients with postoperative pancreatic fistula, additional percutaneous catheter drainage procedures were performed less often (52% vs 84.6%, P = .012), with fewer drainage procedures (median [range], 2 [1–4] vs 2, [1–7], P = .014) after minimally invasive distal pancreatectomy. ConclusionIn this post hoc analysis, the postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was higher than that after open distal pancreatectomy, whereas the clinical impact was less.
Highlights
Twitter: @CaspervaneijckN. van der Heijde et al / Surgery xxx (2021) 1e7Several risk factors6e9 and preventive strategies10e12 for POPF have been proposed
In this article we report the findings of this post hoc analysis of the Closure of Pancreatic Remnant (CPR) trial
In 1 patient, the drain was left in situ based on high drain production; drain amylase was not measured. This post hoc analysis of a multicenter randomized trial demonstrated a considerably lower clinical impact of POPF after MIDP compared to ODP
Summary
Twitter: @CaspervaneijckN. van der Heijde et al / Surgery xxx (2021) 1e7Several risk factors6e9 and preventive strategies10e12 for POPF have been proposed. Because POPF was the primary outcome and both MIDP and ODP were included, the data originating from this study allowed for a post hoc analysis on the incidence, and the clinical impact of POPF after MIDP and ODP. Previous studies reported a higher rate of postoperative pancreatic fistula after minimally invasive distal pancreatectomy compared to open distal pancreatectomy. Methods: This is a post hoc analysis of a multicenter randomized trial investigating a possible beneficial impact of a fibrin patch on the rate of clinically relevant postoperative pancreatic fistula (International Study Group for Pancreatic Surgery grade B/C) after distal pancreatectomy. Conclusion: In this post hoc analysis, the postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was higher than that after open distal pancreatectomy, whereas the clinical impact was less
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