Background Postoperative pancreatic fistula (POPF) remains the main cause of morbidity after left pancreatectomy (LP), but the impact of pancreatic transection level on postoperative outcomes remains debated. Methods We retrospectively analyzed a prospectively maintained single-center database of consecutive patients undergoing LP for malignant, premalignant, or benign disease between 2016 and 2024. Transection level was classified as standard pancreatic body–tail resection (PBTR), pancreatic neck–body–tail/extended resection (PNBTR/e-PNBTR), or pancreatic tail resection (PTR). The primary endpoint was clinically relevant POPF. Secondary endpoints included post-pancreatectomy fluid collections, organ/space surgical site infection (O/S-SSI), post-pancreatectomy hemorrhage (PPH), major complications, mortality, and endocrine/exocrine insufficiency. Associations were assessed using multivariable logistic regression, propensity-score matching, sensitivity analyses, and C-index comparison. Results Among 971 patients, transection was PBTR in 661 (68.1%), PNBTR/e-PNBTR in 116 (11.9%), and PTR in 194 (20.0%). POPF occurred in 205 patients (21.1%) and was more frequent after non-standard transections (PBTR 17.3%, PNBTR/e-PNBTR 31.9%, PTR 27.8%; p<0.001). In multivariable analysis, PNBTR/e-PNBTR (OR 1.87, 95% CI 1.05–3.28) and PTR (OR 2.07, 95% CI 1.19–3.58) were associated with POPF versus PBTR. The association persisted after propensity-score matching but was attenuated after adjustment for pancreatic thickness and stump management. PNBTR/e-PNBTR was associated with PPH, and both non-standard transections with O/S-SSI. Conclusions Transection level was associated with POPF, O/S-SSI, and PPH after LP, supporting its role as an intraoperative marker of anatomical and technical complexity.
Transection Level Matters: A Prospective Study on Pancreatic Fistula Risk After Left Pancreatectomy
Nepi, Angelica;De Pastena, Matteo;Lionetto, Gabriella;Paiella, Salvatore;Ingaglio, Naomi;Casule, Valeria;Tondato, Susanna;Malleo, Giuseppe;Salvia, Roberto
In corso di stampa
Abstract
Background Postoperative pancreatic fistula (POPF) remains the main cause of morbidity after left pancreatectomy (LP), but the impact of pancreatic transection level on postoperative outcomes remains debated. Methods We retrospectively analyzed a prospectively maintained single-center database of consecutive patients undergoing LP for malignant, premalignant, or benign disease between 2016 and 2024. Transection level was classified as standard pancreatic body–tail resection (PBTR), pancreatic neck–body–tail/extended resection (PNBTR/e-PNBTR), or pancreatic tail resection (PTR). The primary endpoint was clinically relevant POPF. Secondary endpoints included post-pancreatectomy fluid collections, organ/space surgical site infection (O/S-SSI), post-pancreatectomy hemorrhage (PPH), major complications, mortality, and endocrine/exocrine insufficiency. Associations were assessed using multivariable logistic regression, propensity-score matching, sensitivity analyses, and C-index comparison. Results Among 971 patients, transection was PBTR in 661 (68.1%), PNBTR/e-PNBTR in 116 (11.9%), and PTR in 194 (20.0%). POPF occurred in 205 patients (21.1%) and was more frequent after non-standard transections (PBTR 17.3%, PNBTR/e-PNBTR 31.9%, PTR 27.8%; p<0.001). In multivariable analysis, PNBTR/e-PNBTR (OR 1.87, 95% CI 1.05–3.28) and PTR (OR 2.07, 95% CI 1.19–3.58) were associated with POPF versus PBTR. The association persisted after propensity-score matching but was attenuated after adjustment for pancreatic thickness and stump management. PNBTR/e-PNBTR was associated with PPH, and both non-standard transections with O/S-SSI. Conclusions Transection level was associated with POPF, O/S-SSI, and PPH after LP, supporting its role as an intraoperative marker of anatomical and technical complexity.
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