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

被引：50

作者：

Miao, Yi ^{[1
]}

Lu, Zipeng ^{[1
]}

Yeo, Charles J. ^{[2
]}

Vollmer, Charles M., Jr. ^{[3
]}

Fernandez-del Castillo, Carlos ^{[4
]}

Ghaneh, Paula ^{[5
]}

Halloran, Christopher M. ^{[5
]}

Kleeff, Jorg ^{[6
]}

de Rooij, Thijs ^{[7
]}

Werner, Jens ^{[8
]}

Falconi, Massimo ^{[9
]}

Friess, Helmut ^{[10
]}

Zeh, Herbert J. ^{[11
]}

Izbicki, Jakob R. ^{[12
]}

He, Jin ^{[13
]}

Laukkarinen, Johanna ^{[14
]}

Dejong, Cees H. ^{[15
]}

Lillemoe, Keith D. ^{[4
]}

Conlon, Kevin ^{[16
]}

Takaori, Kyoichi ^{[17
]}

Gianotti, Luca ^{[18
,19
]}

Besselink, Marc G. ^{[7
]}

Del Chiaro, Marco ^{[20
]}

Montorsi, Marco ^{[21
,22
]}

Tanaka, Masao ^{[23
]}

Bockhorn, Maximilian

Adham, Mustapha ^{[24
]}

Olah, Attila ^{[25
]}

Salvia, Roberto ^{[26
]}

Shrikhande, Shailesh V. ^{[27
]}

Hackert, Thilo ^{[28
]}

Shimosegawa, Tooru ^{[29
]}

Zureikat, Amer H. ^{[30
]}

Ceyhan, Guralp O. ^{[31
]}

Peng, Yunpeng ^{[1
]}

Wang, Guangfu ^{[1
]}

Huang, Xumin ^{[1
]}

Dervenis, Christos ^{[32
]}

Bassi, Claudio ^{[26
]}

Neoptolemos, John P. ^{[28
]}

Buchler, Markus W. ^{[28
]}

机构：

[1] Nanjing Med Univ, Pancreas Ctr, Affiliated Hosp 1, 300 Guangzhou Rd, Nanjing, Jiangsu, Peoples R China

[2] Thomas Jefferson Univ, Jefferson Pancreas Biliary & Related Canc Ctr, Philadelphia, PA 19107 USA

[3] Univ Penn, Dept Surg, Penn Perelman Sch Med, Philadelphia, PA 19104 USA

[4] Harvard Med Sch, Massachusetts Gen Hosp, Boston, MA 02115 USA

[5] Univ Liverpool, Dept Mol & Clin Canc Med, Liverpool, Merseyside, England

[6] Martin Luther Univ Halle Wittenberg, Dept Surg, Halle, Germany

[7] Univ Amsterdam, Dept Surg, Canc Ctr Amsterdam, Amsterdam UMC, Amsterdam, Netherlands

[8] Ludwig Maximilians Univ Munchen, Dept Gen Visceral & Transplantat Surg, Munich, Germany

[9] Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Pancreat Surg Unit, Pancreas Translat & Clin Res Ctr, Milan, Italy

[10] Tech Univ Munich, Sch Med, Dept Surg, Klinikum Rechts Isar, Munich, Germany

[11] Univ Texas Southwestern Med Ctr Dallas, Dept Surg, Dallas, TX 75390 USA

[12] Univ Med Ctr Hamburg Eppendorf, Dept Gen Visceral & Thorac Surg, Hamburg, Germany

[13] Johns Hopkins Univ Hosp, Dept Surg, Baltimore, MD 21287 USA

[14] Univ Tampere, Tampere Univ Hosp, Fac Med & Life Sci, Dept Gastroenterol & Alimentary Tract Surg, Tampere, Finland

[15] Maastricht Univ, Dept Surg, Med Ctr, Maastricht, Netherlands

[16] Univ Dublin, Trinity Coll, Prof Surg Unit, Dublin, Ireland

[17] Kyoto Univ, Dept Surg, Grad Sch Med, Kyoto, Japan

[18] Milano Bicocca Univ, Sch Med & Surg, San Gerardo Hosp, Monza, Italy

[19] San Gerardo Hosp, Dept Surg, Monza, Italy

[20] Univ Colorado, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA

[21] Humanitas Univ, Milan, Italy

[22] Res Hosp IRCCS, Milan, Italy

[23] Kyushu Univ, Shimonoseki City Hosp, Shimonoseki, Yamaguchi, Japan

[24] UCBL1, Hosp Edouard Herriot, Dept Digest & HPB Surg, HCL, Lyon, France

[25] Petz Aladar Hosp, Gyor, Hungary

[26] Verona Univ Hosp, Pancreas Inst, Dept Surg, Verona, Italy

[27] Tata Mem Hosp, Dept Gastrointestinal & HPB Surg Oncol, Mumbai, Maharashtra, India

[28] Heidelberg Univ, Dept Gen Visceral & Transplantat Surg, Heidelberg, Germany

[29] Tohoku Univ, Div Gastroenterol, Grad Sch Med, Sendai, Miyagi, Japan

[30] Univ Pittsburgh, Div Surg Oncol, Med Ctr, Pittsburgh, PA USA

[31] Acibadem Mehmet Ali Aydinlar Univ, Sch Med, Dept Gen Surg, Istanbul, Turkey

[32] Univ Cyprus, Sch Med, Nicosia, Cyprus

来源：

SURGERY | 2020年 / 168卷 / 01期

关键词：

RANDOMIZED CONTROLLED-TRIAL; TO-MUCOSA PANCREATICOGASTROSTOMY; STAPLE LINE REINFORCEMENT; POLYGLYCOLIC ACID FELT; HAND-SEWN CLOSURE; STUMP CLOSURE; RISK-FACTORS; FISTULA FORMATION; REMNANT CLOSURE; SOFT COAGULATION;

D O I：

10.1016/j.surg.2020.02.018

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines. Methods: Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the level of objective support for each. Results: Studies using the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula including 16 randomized trials were reviewed to generate a series of statements set into 14 domains. There was strong consensus in the following statements: there was no difference in the postoperative pancreatic fistula rate after left pancreatectomy between the handsewn and stapler techniques; a stapling technique could not be used in all cases of left pancreatectomy; the use of an energy-based tissue sealant or a chemical sealant device or combinations of these did not impact the postoperative pancreatic fistula rate; there was no difference in the postoperative pancreatic fistula rate between the open, laparoscopic, or robotic approaches; and there are 1 or more clinically important, patient-related risk factors associated with the postoperative pancreatic fistula rate. There was weak or conditional agreement on the use of prophylactic somatostatin analogs, stents, stump closure, stump anastomosis, and the role of abdominal drains. Conclusion: Areas of strong consensus suggests a change in clinical practice and priority setting. Eight domains with lower agreement will require novel approaches and large multicenter studies to determine future key areas of practice. (C) 2020 Elsevier Inc. All rights reserved.

引用

页码：72 / 84

页数：13

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