Relationship between pancreatic thickness and staple height is relevant to the occurrence of pancreatic fistula after distal pancreatectomy

Motokazu Sugimoto, Michael Kendrick, Michael B. Farnell, Shogo Nomura, Naoki Takahashi, Tatsushi Kobayashi, Shin Kobayashi, Shinichiro Takahashi, Masaru Konishi, Naoto Gotohda

Research output: Contribution to journalArticle

Abstract

Background: A triple-row stapler is widely used to divide the pancreas in distal pancreatectomy (DP). However, the selection criteria of the stapler cartridge to prevent postoperative pancreatic fistula (POPF) remain unclear. The objective of this study was to determine if factors concerning pancreatic thickness or staple size affect POPF after DP. Methods: Datasets of patients from the Mayo Clinic and National Cancer Center Hospital East who underwent DP using a triple-row stapler were merged. Risk of POPF was analyzed using clinicopathological variables, including data for pancreatic thickness and staple height. A compression index was defined as the designated staple height (mm) after closure divided by the pancreatic thickness (mm). Results: Among the 277 patients, POPF occurred in 65 (23%) patients. The median pancreatic thickness was 13.7 mm and the median compression index was 0.137. Multivariable logistic models showed that a greater pancreatic thickness (odds ratio, 1.190, P < 0.001) and a compression index ≤0.160 (odds ratio, 4.754, P < 0.001) were independently related with POPF. Conclusion: In patients undergoing DP using a triple-row stapler, the thickness of the pancreas was related with the occurrence of POPF. Selection of the stapler cartridge with a compression index of ≤0.160 may reduce the occurrence of POPF.

Original languageEnglish (US)
Pages (from-to)398-404
Number of pages7
JournalHPB
Volume22
Issue number3
DOIs
StatePublished - Mar 2020

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Sugimoto, M., Kendrick, M., Farnell, M. B., Nomura, S., Takahashi, N., Kobayashi, T., Kobayashi, S., Takahashi, S., Konishi, M., & Gotohda, N. (2020). Relationship between pancreatic thickness and staple height is relevant to the occurrence of pancreatic fistula after distal pancreatectomy. HPB, 22(3), 398-404. https://doi.org/10.1016/j.hpb.2019.07.010