Risk factors for achieving textbook outcome after laparoscopic duodenum-preserving total pancreatic head resection: a retrospective cohort study

Abstract

Introduction: The risk factors for achieving textbook outcome (TO) after laparoscopic duodenum-preserving total pancreatic head resection (LDPPHR-t) are unknown, and no relevant articles have been reported so far. The aim of this study was to identify the risk factors for achieving TO after LDPPHR-t. Methods: The risk factors for achieving TO after LDPPHR-t were retrospectively evaluated by logistic regression analysis in 31 consecutive patients from May 2020 to December 2021. Results: All LDPPHR-t procedures were successfully performed without conversion. There was no death within 90 days after surgery and no readmission within 30 days after discharge. The percentage of achieving TO after LDPPHR-t was 61.3% (19/31). Among the six TO items, the postoperative complication of grade B/C postoperative pancreatic fistula (POPF) occurred most frequently with 22.6%, followed by grade B/C bile leakage with 19.4%, Clavien–Dindo≥III complications with 19.4%, and grade B/C postpancreatectomy hemorrhage with 16.1%. POPF was the major obstacle to achieve TO after LDPPHR-t. Placing an endoscopic nasobiliary drainage (ENBD) catheter and prolonged operation time (>311 min) were significantly associated with the decreased probability of achieving TO after LDPPHR-t (odd ratio (OR), 25.775; P=0.012 and OR, 16.378; P=0.020, respectively). Placing an ENBD catheter was the only significant independent risk factor for POPF after LDPPHR-t (OR, 19.580; P=0.017). Bile leakage was the independent risk factor for postpancreatectomy hemorrhage after LDPPHR-t (OR, 15.754; P=0.040). The prolonged operation time was significantly correlated with Clavien–Dindo grade≥III complications after LDPPHR-t (OR, 19.126; P=0.024). Conclusion: Placing the ENBD catheter was the independent risk factor for POPF and achieving TO after LDPPHR-t. In order to reduce POPF and increase the probability of achieving TO, placing an ENBD catheter should be avoided prior to LDPPHR-t.

Association of textbook outcomes with improved survival in pancreatic ductal adenocarcinoma following pancreaticoduodenectomy: a retrospective study

“…Interestingly, we found statistically significant differences between the two groups in laboratory test results on the third day after surgery (including the proportion of neutrophils, amylase levels in drainage fluid, and other factors related to POPF). This suggests that POPF is a critical postoperative complication to be concerned about, which is consistent with the current high-priority scientific issues in PD ( 24 , 46 ). POPF is likely to act as a focal point and trigger for other postoperative complications, such as abdominal infections and PPH.…”

“…Furthermore, the researchers used TO as a primary indicator to evaluate the short-term surgical outcomes of Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR-t) and found that POPF was the primary barrier to achieving TO after LDPPHR-t. Placement of an endoscopic nasobiliary drainage (ENBD) tube was recognized as the only significant independent risk factor for developing POPF following LDPPHR-t surgery. Their researches used TO to explore possible avenues for improving the quality of PD ( 24 ). The widespread adoption of neoadjuvant therapy in unresectable pancreatic ductal adenocarcinoma (PDAC) has made pancreatic surgery more complex and challenging.…”

The application of intraoperative vascular and biliary tract imaging in laparoscopic duodenum-preserving pancreatic head resection

“…Pancreatic stula is the most important complication after DPPHR [21,22]. A soft texture of the pancreas and a diameter of the pancreatic duct less than 3 mm in benign pancreatic tumors are the main risk factors for pancreatic stula [23,24]. In addition, residual pancreatic tissue is also a potential risk factor for pancreatic stula.…”