Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Definitions
2.3. Operative Technique
2.4. Statistical Analysis
2.5. Evaluation Factors
2.5.1. Patient-Specific Factors
2.5.2. Surgery-Related Factors
2.5.3. Pathologic Factors
3. Results
3.1. Patients’ Demographics and Tumor Factors
3.2. Surgical Technique and Operative Details
3.3. In-Hospital Complications
3.4. Logistic Regression Analysis of Risk Factors for Post-LDP Complications
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristic | ||
---|---|---|
Patients, n | 1227 | |
Age, years, mean ± SD | 52.9 ± 14 | |
Sex, female:male (n) | 729:498 | |
BMI, kg/m2, mean ± SD | 23.7 ± 3.1 | |
ASA score, mean ± SD | 1.8 (0.5) | |
Tumor size, cm, mean ± SD | 3.6 ± 2.3 | |
Diagnosis | n | % |
Pancreatic cancer | 218 | 17.8 |
Pancreatic ductal adenocarcinoma | 196 | |
Intraductal papillary mucinous carcinoma | 12 | |
Adenosquamous cancer | 3 | |
Mixed acinar-neuroendocrine carcinoma | 2 | |
Sarcomatoid cancer | 2 | |
Anaplastic carcinoma | 1 | |
Intraductal papillary mucinous neoplasm (IPMN) | 238 | 19.4 |
IPMN low-grade dysplasia | 122 | |
IPMN intermediate-grade dysplasia | 99 | |
IPMN high-grade dysplasia | 17 | |
Pancreatic neuroendocrine tumor (PNET) | 122 | 9.9 |
PNET grade 1 | 64 | |
PNET grade 2 | 26 | |
PNET grade 3 | 7 | |
PNET unknown grade | 25 | |
Solid pseudopapillary neoplasm | 178 | 14.5 |
Mucinous cyst neoplasm | 168 | 13.7 |
Serous cyst neoplasm | 142 | 11.6 |
Pancreatitis (with or without pseudocyst) | 78 | 6.4 |
Other pancreatic tumors | 35 | 2.9 |
Procedure | Patients (N = 1227) | ||
---|---|---|---|
n | % | ||
LDPS | 654 | 53.3 | |
LDPS only | 539 | 43.9 | |
LDPS with combined operation | 115 | 9.4 | |
LDPS + Lap.SWR | 19 | ||
LDPS + Lap.SWR + Lap.CR | 2 | ||
LDPS + Lap.CR | 11 | ||
LDPS + Lap.CR + LC | 2 | ||
LDPS + Lap.CR + LC + Lap. ovarian resection | 1 | ||
LDPS + LC | 67 | ||
LDPS + Lap. ovarian resection | 2 | ||
LDPS + Lap. partial nephrectomy | 1 | ||
LDPS + Lap. portal vein resection | 3 | ||
LDPS + Lap. liver resection + LC | 2 | ||
LDPS + Lap. liver resection | 1 | ||
LDPS + Lap.SBR | 4 | ||
SP-LDP | 573 | 46.7 | |
SVP-SP-LDP | 417 | 33.7 | |
SVP-SP-LDP only | 367 | ||
SVP-SP-LDP with combined operation | 50 | ||
SVP-SP-LDP + LC | 41 | ||
SVP-SP-LDP +LDG | 3 | ||
SVP-SP-LDP + Lap-liver resection + LC | 1 | ||
SVP-SP-LDP + Lap-resection of hepatic cyst | 2 | ||
SVP-SP-LDP + Lap-ovarian resection | 1 | ||
SVP-SP-LDP + Lap-appendectomy | 2 | ||
SP-LDP with splenic vessels ligation (Lap-Warshaw) | 156 | 12.6 | |
Lap-Warshaw only | 145 | ||
Lap-Warshaw with combined operation | 11 | ||
Lap-Warshaw + LC | 10 | ||
Lap-Warshaw + Lap-ovarian resection | 1 |
Surgical Complications with Clavien Classification | N = 1227 | % |
---|---|---|
No. | 1065 | 86.8 |
Grade I | 6 | 0.5 |
Chylous ascites with low long-chain triglyceride diet | 3 | |
Superficial wound infection with bedside care | 2 | |
Atelectasis | 1 | |
Grade II | 115 | 9.4 |
Pancreatic fistula or intra-abdominal fluid collection with antibiotic therapy | 97 | |
Ileus | 6 | |
Postoperative bleeding with transfusion | 5 | |
Delayed gastric emptying | 2 | |
Tractitis (drain insertion site) | 1 | |
Portal vein thrombus with anticoagulant therapy | 1 | |
Wound dehiscence | 1 | |
Postoperative delirium | 1 | |
Cerebral infarction with anticoagulant therapy | 1 | |
Grade III | 41 | 3.4 |
Grade IIIa | 34 | 2.8 |
Pancreatic fistula grade B with intervention therapy | 32 | |
EUS-guided gastrocystostomy | 16 | |
Percutaneous drainage | 11 | |
ERPD or ENPD insertion | 5 | |
Intra-abdominal fluid collection with drainage | 1 | |
Splenic artery aneurysmal bleeding with embolization | 1 | |
Grade IIIb | 7 | 0.6 |
Postoperative bleeding with reoperation | 4 | |
Mechanical ileus with reoperation | 2 | |
Common bile duct injury with reoperation | 1 | |
2016 International Study Group Pancreatic Fistula | ||
No | 681 | 55.5 |
Biochemical leak | 488 | 39.8 |
Grade B | 58 | 4.7 |
Factors | No. of Patients | Univariate (p) | Odds Ratio (95% CI) | Multivariate (p) |
---|---|---|---|---|
Overall complication | ||||
Age (years) | 0.715 | |||
70 | 1086 (88.5%) | |||
70 | 141 (11.5%) | |||
Sex | 0.003 | 0.124 | ||
Female | 729 (59.4%) | |||
Male | 498 (40.6%) | 1.317 (0.927–1.872) | ||
ASA score | 0.516 | |||
1 | 262 (21.4%) | |||
2 | 923 (75.2%) | 0.827 | ||
3 | 42 (3.4%) | 0.260 | ||
BMI | 0.210 | |||
Normal | 799 (65.1%) | |||
Overweight | 350 (28.5%) | 0.165 | ||
Obese | 36 (2.9%) | 0.200 | ||
Preoperative albumin level | 0.109 | |||
3.5 g/dL | 163 (13.3%) | |||
3.5 g/dL | 1064 (86.7%) | |||
Operative time | 0.001 | 0.001 | ||
200 min | 691 (56.3%) | |||
200 min | 536 (43.7%) | 1.915 (1.341–2.735) | ||
Estimated blood loss | 0.001 | 0.002 | ||
320 mL | 1135 (92.5%) | |||
320 mL | 92 (7.5%) | 2.201 (1.322–3.664) | ||
Surgeon’s experience | 0.001 | 0.001 | ||
Inexperienced | 189 (15.4%) | |||
Experienced | 1038 (84.6%) | 0.442 (0.297–0.658) | ||
Splenectomy | 0.001 | 0.001 | ||
Yes | 654 (53.3%) | |||
No | 573 (46.7%) | 0.460 (0.314–0.673) | ||
Multivisceral resection | 0.432 | |||
No | 1180 (96.2%) | |||
Yes | 47 (3.8%) | |||
Length of resection | 0.702 | |||
12 cm | 979 (79.8%) | |||
12 cm | 241 (19.6%) | |||
Malignancy | 0.136 | |||
Benign | 978 (79.7%) | |||
Malignant | 249 (20.3%) | |||
Major complication | ||||
Age (years) | 0.723 | |||
70 | 1086 (88.5%) | |||
70 | 141 (11.5%) | |||
Sex | 0.009 | 0.020 | ||
Female | 729 (59.4%) | |||
Male | 498 (40.6%) | 2.142 (1.125–4.079) | ||
ASA score | 0.733 | |||
1 | 262 (21.4%) | |||
2 | 923 (75.2%) | 0.431 | ||
3 | 42 (3.4%) | 0.998 | ||
BMI | 0.752 | |||
Normal | 799 (65.1%) | |||
Overweight | 350 (28.5%) | 0.837 | ||
Obese | 36 (2.9%) | 0.490 | ||
Preoperative albumin level | 0.102 | |||
3.5 g/dL | 163 (13.3%) | |||
3.5 g/dL | 1064 (86.7%) | |||
Operative time | 0.002 | 0.005 | ||
200 min | 691 (56.3%) | |||
200 min | 536 (43.7%) | 2.648 (1.352–5.189) | ||
Estimated blood loss | 0.023 | 0.230 | ||
320 mL | 1135 (92.5%) | |||
320 mL | 92 (7.5%) | 1.718 (0.711–4.154) | ||
Surgeon’s experience | 0.015 | 0.026 | ||
Inexperienced | 189 (15.4%) | |||
Experienced | 1038 (84.6%) | 0.453 (0.225–0.912) | ||
Splenectomy | 0.026 | 0.337 | ||
Yes | 654 (53.3%) | |||
No | 573 (46.7%) | 0.702 (0.341–1.446) | ||
Multivisceral resection | 0.247 | |||
No | 1180 (96.2%) | |||
Yes | 47 (3.8%) | |||
Length of resection | 0.968 | |||
12 cm | 979 (79.8%) | |||
12 cm | 241 (19.6%) | |||
Malignancy | 0.150 | |||
Benign | 978 (79.7%) | |||
Malignant | 249 (20.3%) |
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Song, K.B.; Hong, S.; Kim, H.J.; Park, Y.; Kwon, J.; Lee, W.; Jun, E.; Lee, J.H.; Hwang, D.W.; Kim, S.C. Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy. J. Clin. Med. 2020, 9, 2766. https://doi.org/10.3390/jcm9092766
Song KB, Hong S, Kim HJ, Park Y, Kwon J, Lee W, Jun E, Lee JH, Hwang DW, Kim SC. Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy. Journal of Clinical Medicine. 2020; 9(9):2766. https://doi.org/10.3390/jcm9092766
Chicago/Turabian StyleSong, Ki Byung, Sarang Hong, Hwa Jung Kim, Yejong Park, Jaewoo Kwon, Woohyung Lee, Eunsung Jun, Jae Hoon Lee, Dae Wook Hwang, and Song Cheol Kim. 2020. "Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy" Journal of Clinical Medicine 9, no. 9: 2766. https://doi.org/10.3390/jcm9092766