A preliminary study on different reconstruction methods of distal pancreas after robotic central pancreatectomy

doi:10.3877/cma.j.issn.1674-6899.2024.05.008

Abstract

Abstract:

Objective

To explore the surgical safety of robotic central pancreatectomy and compare the efficacy of different methods of reconstruction for the distal pancreatic stump.

Methods

Clinical data of 10 patients who underwent robotic central pancreatectomy from Jun. 2018 to Aug. 2022 were retrospectively analyzed to evaluate short-term clinical outcomes and long-term prognosis.The operative time， intraoperative blood loss， postoperative hospital stay， postoperative pancreatic fistula， peritoneal hemorrhage， incidence of peritoneal infection， and long-term abnormal pancreatic secretory function were analyzed.

Results

Among the 10 patients， there were 3 males and 7 females， with an average age of 47.2±11.5 years and an average body mass index（BMI）of 22.5±2.9 kg/m². The methods of reconstruction of the distal pancreatic stump included pancreaticojejunostomy in 4 cases， pancreatogastric anastomosis in 3 cases， and end-to-end pancreatic anastomosis in 3 cases. The average operation time was 273.0±54.4 minutes， and the average intraoperative blood loss was 120.0±45.8 ml. After the surgery， biochemical leakage occurred in 4 patients，and 3 patients developed Grade B pancreatic fistula. Among them， 1 case combined with gastrointestinal bleeding and abdominal infection （Klebsiella pneumonia） who underwent puncture drainage， while the other 2 cases underwent endoscopic pancreatic duct stent placement. Pathological examination revealed 2 cases of serous cystadenoma， 2 cases of mucinous cystadenoma， 2 cases of pancreatic neuroendocrine tumors， 3 cases of intraductal papillary mucinous neoplasms （IPMN）， and 1 case of renal cell carcinoma metastases. The average length of hospital stay was 14.0±7.7 days. The average follow-up period was 33. 8±14. 3 months. All the 10 patients had distal pancreatic atrophy. None of the patients developed endocrine or exocrine insufficiency.

Conclusion

Robotic central pancreatectomy is safe and feasible. Although there is a relatively high incidence of pancreatic fistula in the early postoperative period，long-term pancreatic exocrine and endocrine functions are not significantly affected，high-quality studies are warranted to verify the conclusion.

Key words: Pancreatic tumor, obotic surgery, Central pancreatectomy, Postoperativecurative effect

Kongyuan Wei, Zheng Wu, Zheng Wang, Wei Li. A preliminary study on different reconstruction methods of distal pancreas after robotic central pancreatectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(05): 295-300.

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References 20

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序号	年龄（岁）	性别	BMI（kg/m²）	肿瘤最大径（cm）	切除胰腺长度（cm）	切缘（mm）	远端胰管宽度（mm）	病理诊断	重建方式
1	39	男	24.4	3	4	8	1	SCN	胰肠吻合
2	62	女	23.1	3	5	5	2	MCN	胰肠吻合
3	46	女	21.1	1.5	3.5	1	13	无功能性p-NET	胰胃吻合
4	49	女	15.6	2	4	6	2	IPMN	胰胃吻合
5	37	女	19.5	4	5	5	2	SCN	端端吻合
6	40	女	22.7	4	6	8	2	IPMN	胰胃吻合
7	73	女	23.7	2	4	5	2	胰腺转移癌	端端吻合
8	51	女	25.0	3	4	6	2	IPMN	端端吻合
9	40	男	24.5	1.5	5	18	3	胰岛素瘤	胰肠吻合
10	35	男	25.4	3.5	5	5	1	MCN	胰肠吻合

序号	年龄（岁）	性别	BMI（kg/m²）	肿瘤最大径（cm）	切除胰腺长度（cm）	切缘（mm）	远端胰管宽度（mm）	病理诊断	重建方式
1	39	男	24.4	3	4	8	1	SCN	胰肠吻合
2	62	女	23.1	3	5	5	2	MCN	胰肠吻合
3	46	女	21.1	1.5	3.5	1	13	无功能性p-NET	胰胃吻合
4	49	女	15.6	2	4	6	2	IPMN	胰胃吻合
5	37	女	19.5	4	5	5	2	SCN	端端吻合
6	40	女	22.7	4	6	8	2	IPMN	胰胃吻合
7	73	女	23.7	2	4	5	2	胰腺转移癌	端端吻合
8	51	女	25.0	3	4	6	2	IPMN	端端吻合
9	40	男	24.5	1.5	5	18	3	胰岛素瘤	胰肠吻合
10	35	男	25.4	3.5	5	5	1	MCN	胰肠吻合

序号	手术时间（min）	术中出血（ml）	术中输血	胰瘘	腹腔/消化道出血	腹腔感染	术后住院时间（d）	拔管时间
1	270	100	无	B级胰瘘	消化道出血	肺炎克雷伯菌	35	术后2月
2	180	100	无	无	无	无	7	住院期间
3	210	100	无	生化漏	无	无	12	术后3周
4	240	100	无	无	无	无	12	住院期间
5	270	100	无	B级胰瘘	无	无	14	术后2月行ERCP+胰管支架置入后拔管
6	300	100	无	生化漏	无	无	10	术后3周
7	240	200	无	生化漏	无	无	16	术后3月
8	330	50	无	B级胰瘘	无	无	8	术后半年行ERCP+胰管支架置入后拔管
9	360	150	无	无	无	无	17	住院期间
10	330	200	无	生化漏	无	无	9	术后3周

序号	手术时间（min）	术中出血（ml）	术中输血	胰瘘	腹腔/消化道出血	腹腔感染	术后住院时间（d）	拔管时间
1	270	100	无	B级胰瘘	消化道出血	肺炎克雷伯菌	35	术后2月
2	180	100	无	无	无	无	7	住院期间
3	210	100	无	生化漏	无	无	12	术后3周
4	240	100	无	无	无	无	12	住院期间
5	270	100	无	B级胰瘘	无	无	14	术后2月行ERCP+胰管支架置入后拔管
6	300	100	无	生化漏	无	无	10	术后3周
7	240	200	无	生化漏	无	无	16	术后3月
8	330	50	无	B级胰瘘	无	无	8	术后半年行ERCP+胰管支架置入后拔管
9	360	150	无	无	无	无	17	住院期间
10	330	200	无	生化漏	无	无	9	术后3周

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