Observational studySurgical endoscopy2025
Impact of the stapler method on postoperative pancreatic fistula in robot-assisted pancreaticoduodenectomy: a retrospective study.
Observational study in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostoperative pancreatic fistula (POPF) remains a significant complication after pancreaticoduodenectomy. However, optimal techniques for pancreatic transection to minimize the risk of POPF have not been thoroughly elucidated. This study aimed to evaluate the impact of stapler-assisted pancreatic transection and reconstruction (stapler method) on the incidence of clinically relevant POPF (CR-POPF) and to present the technical details of the stapler method, accompanied by supplementary video footage.
methodsA retrospective review was conducted on patients who underwent robot-assisted pancreaticoduodenectomy (RPD) between October 2020 and December 2024. Patients were categorized into the stapler method group and the conventional method group, in which pancreatic transection was performed using a coagulation-based technique. The incidence and risk factors for CR-POPF were analyzed, and post-pancreatectomy acute pancreatitis (PPAP) was also evaluated.
resultsA total of 134 patients who underwent RPD were included in this study, with 61 in the stapler method group and 73 in the conventional method group. The incidence of CR-POPF was significantly lower in the stapler method group compared to the conventional method group (13.1% vs. 31.5%, p = 0.014). In multivariate analysis, body mass index was independently associated with an increased risk of CR-POPF (OR, 1.34; 95% CI, 1.14-1.57; p < 0.001), while the stapler method was associated with a significantly reduced risk (OR, 0.31; 95% CI, 0.12-0.80; p = 0.016). Although postoperative serum amylase levels on postoperative day 1 were significantly higher in the stapler method group (578 U/L; IQR, 292-1107) than in the conventional method group (336 U/L; IQR, 242-830; p = 0.020), the incidence of PPAP did not significantly differ between the groups (stapler method: 1.6% vs. conventional method: 1.4%, p = 1.000).
conclusionsThese findings suggest that the stapler method may reduce the incidence of CR-POPF in RPD without increasing the risk of PPAP.
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