Towards zero postoperative pancreatic fistula after distal pancreatectomy: a propensity score matching analysis of pancreatic stump closure with radiofrequency vs stapler

Abstract

Purpose: To demonstrate the efficacy of radiofrequency for pancreatic stump closure in reducing the incidence of postoperative pancreatic fistula (POPF) in distal pancreatectomy (DP) compared with mechanical transection methods. Despite all the different techniques of pancreatic stump closure proposed for DP, best practice for avoiding POPF remains an unresolved issue, with an incidence of up to 30% regardless of center volume or surgical expertise. Method: DP was performed in a cohort of patients by applying radiofrequency to stump closure (RF Group) and compared with mechanical closure (Control Group). A propensity score (PS) matched cohort study was carried out to minimize bias from nonrandomized treatment assignment. Cohorts were matched by PS accounting for factors significantly associated with either undergoing RF transection or mechanical closure through logistic regression analysis. The primary end-point was the incidence of clinically relevant POPF (CR-POPF). Results: Of 89 patients included in the whole cohort, 13 case patients from the RF- Group were 1:1 matched to 13 control patients. In both the first independent analysis of unmatched data and subsequent adjustment to the overall propensity score-matched cohort, a higher rate of CR-POPF in the Control Group compared with the RF-Group was detected (25.4% vs. 5.3%, p=0.049 and 53.8% vs. 0%; p = 0.016 respectively). The RF Group showed better outcomes in terms of readmission rate (46.2% vs 0%, p=0.031). No significant differences were observed in terms of mortality, major complications (30.8% vs 0%, p=0.063) or length of hospital stay (5.7 vs 5.2 days, p=0.89). Conclusion: Findings suggest that the RF-assisted technique is more efficacious in reducing CR-POPF than mechanical pancreatic stump closure. I confirm the evaluation and review of the work of the ethics committee in accordance with Law 14/2007 on Biomedical Research, Principles of the Declaration of Helsinki, and other applicable ethical principles.