Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy

Hongbeom Kim, Jin-Young Jang, Donghee Son, Seungyeoun Lee, Youngmin Han, Yong Chan Shin, Jae Ri Kim, Wooil Kwon, Sun-Whe Kim, Hongbeom Kim, Jin-Young Jang, Donghee Son, Seungyeoun Lee, Youngmin Han, Yong Chan Shin, Jae Ri Kim, Wooil Kwon, Sun-Whe Kim

Abstract

Stapling is a popular method for stump closure in distal pancreatectomy (DP). However, research on which cartridges are suitable for different pancreatic thickness is lacking. To identify the optimal stapler cartridge choice in DP according to pancreatic thickness.From November 2011 to April 2015, data were prospectively collected from 217 consecutive patients who underwent DP with 3-layer endoscopic staple closure in Seoul National University Hospital, Korea. Postoperative pancreatic fistula (POPF) was graded according to International Study Group on Pancreatic Fistula definitions. Staplers were grouped based on closed length (CL) (Group I: CL ≤ 1.5 mm, II: 1.5 mm < CL < 2 mm, III: CL ≥ 2 mm). Compression ratio (CR) was defined as pancreas thickness/CL. Distribution of pancreatic thickness was used to find the cut-off point of thickness which predicts POPF according to stapler groups.POPF developed in 130 (59.9%) patients (Grade A; n = 86 [66.1%], B; n = 44 [33.8%]). The numbers in each stapler group were 46, 101, and 70, respectively. Mean thickness was higher in POPF cases (15.2 mm vs 13.5 mm, P = 0.002). High body mass index (P = 0.003), thick pancreas (P = 0.011), and high CR (P = 0.024) were independent risk factors for POPF in multivariate analysis. Pancreatic thickness was grouped into <12 mm, 12 to 17 mm, and >17 mm. With pancreatic thickness <12 mm, the POPF rate was lowest with Group II (I: 50%, II: 27.6%, III: 69.2%, P = 0.035).The optimal stapler cartridges with pancreatic thickness <12 mm were those in Group II (Gold, CL: 1.8 mm). There was no suitable cartridge for thicker pancreases. Further studies are necessary to reduce POPF in thick pancreases.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) Thickness measurement at resection line: Pancreatic thickness was measured at the resection line in preoperative computed tomography by 1 of the researchers. (B) Compression ratio: CR was defined as pancreas thickness divided by CL for comparing degree of compression. CL = closed length.
Figure 2
Figure 2
(A) Distribution and subgrouping of thickness: The 25th percentile of thickness was 12 mm and the 75th percentile was 17 mm. Thickness was divided into 3 subgroups, below 12 mm, between 12 and 17 mm, and above 17 mm. (B) POPF rate according to the thickness: POPF rate increased as thickness increased. POPF = postoperative pancreatic fistula.
Figure 3
Figure 3
POPF rate according to the stapler group in subgroup analysis: In the thickness 17 mm group, the POPF rate tended to be lower when a longer stapler was used, but this was not statistically significant. POPF = postoperative pancreatic fistula.

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Source: PubMed

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