Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS)

Lu, Zipeng; Yeo, Charles J.; Vollmer, Charles M.; Halloran, Christopher; Rooij, Thijs de; Werner, Jens; Frieß, Helmut; Zeh, Herbert J.; Izbicki, Jakob R.; He, Jin; Laukkarinen, Johanna; Dejong, C. H. C.; Lillemoe, Keith D.; Conlon, Kevin C.; Gianotti, Luca; Besselink, Marc G.; Chiaro, Marco Del; Montorsi, Marco; Bockhorn, Maximilian; Adham, Mustapha; Oláh, Attila; Salvia, Roberto; Hackert, Thilo; Brown, James A; Ceyhan, Güralp O.; Bassi, Claudio; Miao, Yi; Büchler, Markus W.; Castillo, Carlos Fernández‐del; Neoptolemos, John P.; Dervenis, Christos; Ghaneh, Paula; Kleeff, Jörg; Shrikhande, Shailesh V.; Falconi, Massimo; Takaori, Kyoichi; Tanaka, Masao; Shimosegawa, Tooru; Peng, Yunpeng; Wang, Guangfu; Huang, Xumin; Lu, Zheng

doi:10.1016/j.surg.2020.02.018

Cited by 55 publications

(34 citation statements)

References 116 publications

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“…POPF therefore remains a clinically relevant and unsolved issue for patients undergoing elective DP, with a formation process likely independent on the surgical technique adopted for resection and closure of the pancreatic remnant. Our findings indeed resonate with previously published randomized controlled trials that did not identify an optimal transection method able to decrease POPF [30].…”

Section: Discussionsupporting

confidence: 91%

A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy

et al. 2021

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Background The pancreatic transection method during distal pancreatectomy is thought to influence postoperative fistula rates. Yet, the optimal technique for minimizing fistula occurrence is still unclear. The present randomized controlled trial compared stapled versus ultrasonic transection in elective distal pancreatectomy. Methods Patients undergoing distal pancreatectomy from July 2018 to July 2020 at two high-volume institutions were considered for inclusion. Exclusion criteria were contiguous organ resection and a parenchymal thickness > 17 mm on intraoperative ultrasound. Eligible patients were randomized in a 1:1 ratio to stapled transection (Endo GIA Reinforced Reload with Tri-Staple Technology®) or ultrasonic transection (Harmonic Focus® + or Harmonic Ace® + shears). The primary endpoint was postoperative pancreatic fistula. Secondary endpoints included overall complications, abdominal collections, and length of hospital stay. Results Overall, 72 patients were randomized in the stapled transection arm and 73 patients in the ultrasonic transection arm. Postoperative pancreatic fistula occurred in 23 patients (16%), with a comparable incidence between groups (12% in stapled transection versus 19% in ultrasonic dissection arm, p = 0.191). Overall complications did not differ substantially (35% in stapled transection versus 44% in ultrasonic transection arm, p = 0.170). There was an increased incidence of abdominal collections in the ultrasonic dissection group (32% versus 14%, p = 0.009), yet the need for percutaneous drain did not differ between randomization arms (p = 0.169). The median length of stay was 8 days in both groups (p = 0.880). Intraoperative blood transfusion was the only factor independently associated with postoperative pancreatic fistula on logistic regression analysis (OR 4.8, 95% CI 1.2–20.0, p = 0.032). Conclusion The present randomized controlled trial of stapled versus ultrasonic transection in elective distal pancreatectomy demonstrated no significant difference in postoperative pancreatic fistula rates and no substantial clinical impact on other secondary endpoints.

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Section: Discussionsupporting

confidence: 91%

A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy

et al. 2021

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“…4 The International Study Group of Pancreatic Surgery consensus guidelines highlight the lack of clear evidence linking a risk factor or mitigating factor with POPF. 14 These data and our data suggest that the development of POPF may be stochastic, and that techniques yet to be determined are needed to prevent POPF. The reported rate of any organ invasion for RPS is approximately 50%.…”

Section: Discussionmentioning

confidence: 60%

Morbidity and Outcomes After Distal Pancreatectomy for Primary Retroperitoneal Sarcoma: An Analysis by the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group

et al. 2021

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“…However, the predictors proposed in this study are simple and useful for clinical application. Taking into account expert consensus guidelines, 30 we suggest the following for postoperative management after DP: the intraoperatively inserted drains are generally removed in the early phase, and the patients with high-risk factors, such as high CRP or high DFA output on POD 3, should be closely followed-up using imaging modalities to avoid missing the timing of reintervention such as endoscopic transgastric drainage. 31 In conclusion, the present study suggests that the CRP values and DFA output may facilitate appropriate postoperative management after DP.…”

Section: Discussionmentioning

confidence: 99%

Postoperative elevation of C‐reactive protein levels and high drain fluid amylase output are strong predictors of pancreatic fistulas after distal pancreatectomy

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Ogawa

Tamura

et al. 2021

J Hepato Biliary Pancreat

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A postoperative pancreatic fistula (POPF) is one of the severe morbidities after distal pancreatectomy (DP) and occurs in 10%-40% of cases according to previous reports. 1,2 A thick pancreas at the cutting line, high body mass index, and low preoperative albumin were reported as predictors of POPF after DP in the previous studies. [3][4][5][6] Regarding the approach to pancreatic transection during DP, transection by stapler could reduce POPF compared with hand-sewn transection. 7

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Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS)

Cited by 55 publications

References 116 publications

A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy

A randomized controlled trial of stapled versus ultrasonic transection in distal pancreatectomy

Morbidity and Outcomes After Distal Pancreatectomy for Primary Retroperitoneal Sarcoma: An Analysis by the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group

Postoperative elevation of C‐reactive protein levels and high drain fluid amylase output are strong predictors of pancreatic fistulas after distal pancreatectomy

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