Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy

Tomimaru, Yoshito; Kobayashi, Shogo; Sasaki, Kazuki; Hasegawa, Shinichiro; Yamada, Daisaku; Akita, Hirofumi; Noda, Takehiro; Takahashi, Hidenori; Imamura, Hiroki; Doki, Yuichiro; Eguchi, Hidetoshi

doi:https://doi.org/10.1007/s00464-025-11635-2

Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy

Tomimaru, Yoshito; Kobayashi, Shogo; Sasaki, Kazuki et al.

Surgical Endoscopy, 2025, 39(4), 2561-2570

アクセス数:14件（2025-04-28 19:33 集計）

固定URL: https://hdl.handle.net/11094/101005

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タイトル	Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy
著者	NRID 1000070528570 1000070528570 researchmap permalink yoshitotomimaru yoshitotomimaru Scopus Author ID 10240341100 10240341100 著者名 Tomimaru, Yoshito
	NRID 1000030452436 1000030452436 著者名 Kobayashi, Shogo
	NRID 1000020745442 1000020745442 researchmap permalink Kazuki_Sasaki Kazuki_Sasaki Scopus Author ID 56087041900 56087041900 著者名 Sasaki, Kazuki
	NRID 1000060621026 1000060621026 著者名 Hasegawa, Shinichiro
	NRID 1000060571396 1000060571396 ORCID 0000-0002-6702-3800 0000-0002-6702-3800 researchmap permalink dyamada79222 dyamada79222 Scopus Author ID 37008067700 37008067700 著者名 Yamada, Daisaku
	NRID 1000070528463 1000070528463 researchmap permalink hirofumi_akita hirofumi_akita 著者名 Akita, Hirofumi
	NRID 1000050528594 1000050528594 ORCID 0000-0002-6768-5783 0000-0002-6768-5783 researchmap permalink t-noda t-noda Scopus Author ID 12764559600 12764559600 著者名 Noda, Takehiro
	NRID 1000090601120 1000090601120 ORCID 0000-0003-4801-3540 0000-0003-4801-3540 researchmap permalink hdnr_tkhs hdnr_tkhs Scopus Author ID 7405468781 7405468781 著者名 Takahashi, Hidenori
	ORCID 0000-0001-5363-0661 0000-0001-5363-0661 著者名 Imamura, Hiroki
	NRID 1000020291445 1000020291445 researchmap permalink ydoki3251 ydoki3251 Scopus Author ID 7006390687 7006390687 著者名 Doki, Yuichiro
	NRID 1000090542118 1000090542118 researchmap permalink abcdabcdabcd abcdabcdabcd Scopus Author ID 7101627772 7101627772 著者名 Eguchi, Hidetoshi
キーワード等	Hypoattenuated area
	Pancreatic fistula
	Pancreaticoduodenectomy
	Pancreatojejunostomy
	Robotic pancreaticoduodenectomy
内容	The version of record of this article, first published in Surgical Endoscopy, is available online at Publisher’s website: https://doi.org/10.1007/s00464-025-11635-2
抄録	Background: Hypoattenuated area (HA) formation at the pancreatojejunostomy (PJ) site on contrast-enhanced computed tomography (CE-CT) is significantly associated with clinically relevant postoperative pancreatic fistula (CR-POPF) after open pancreaticoduodenectomy (PD) (O-PD). Here, we evaluated the impact of HA formation in robotic PD (R-PD) and surgical factors predictive of HA formation. Methods: The study retrospectively analyzed 66 patients who underwent either O-PD or R-PD and exhibited a drain amylase level exceeding three times the upper limit of normal range, with CE-CT assessment performed on postoperative days 3–14. Patients were divided into two groups, with evident HA (≥ 5 mm) (E-HA) and subtle HA (< 5 mm) (S-HA), and their data were analyzed by multivariate and propensity-score matching analyses. Results: Among the patients, 24 (36.3%) exhibited E-HA and 42 (63.7%) S-HA. The percentages of R-PD and CR-POPF in E-HA group were significantly lower and higher, respectively, than S-HA group (R-PD: 29.2% vs 54.8%, p = 0.0446; CR-POPF: 70.8% vs 4.8%, p < 0.0001). Multivariate analysis revealed the surgical approach as a significant factor associated with E-HA formation (odds ratio: 0.26; p = 0.0223). Propensity-score matching analysis revealed significantly fewer patients with E-HA formation and CR-POPF in R-PD group than O-PD group (E-HA: 14.3% vs 64.3%, p = 0.0068; CR-POPF: 14.3% vs 57.1%, p = 0.0180). Conclusion: The impact of HA formation in predicting CR-POPF was confirmed in the patients undergoing PD, including O-PD and R-PD. Furthermore, the data suggest that R-PD, compared with O-PD, significantly decreased the incidence of E-HA formation, indicating an advantage of R-PD over O-PD in reducing CR-POPF via HA formation.
出版者	Springer
収録物名	Surgical Endoscopy
巻(号)	39(4)
ページ	2561-2570
刊行年月	2025-04-01
言語	英語
ハンドルURL	https://hdl.handle.net/11094/101005
PISSN	09302794
eISSN	14322218
関連情報 (isIdenticalTo)	DOI (出版社版) https://doi.org/10.1007/s00464-025-11635-2
アクセス権	open access
権利情報	This article is licensed under a Creative Commons Attribution 4.0 International License.
出版タイプ	Version of Record
カテゴリ	学術雑誌論文 Journal Article

資源タイプ	学術雑誌論文
ローカル資源タイプ	学術雑誌論文
DCTERMS.bibliographicCitation	Surgical Endoscopy. 2025, 39(4), p. 2561-2570
DC.title	Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy
DC.creator	Tomimaru, Yoshito
	Kobayashi, Shogo
	Sasaki, Kazuki
	Hasegawa, Shinichiro
	Yamada, Daisaku
	Akita, Hirofumi
	Noda, Takehiro
	Takahashi, Hidenori
	Imamura, Hiroki
	Doki, Yuichiro
	Eguchi, Hidetoshi
DC.publisher	Springer
DC.language' scheme='DCTERMS.RFC1766	英語
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2025-04-01
DC.identifier	https://doi.org/10.1007/s00464-025-11635-2
DC.subject	Hypoattenuated area
	Pancreatic fistula
	Pancreaticoduodenectomy
	Pancreatojejunostomy
	Robotic pancreaticoduodenectomy
DC.description	The version of record of this article, first published in Surgical Endoscopy, is available online at Publisher’s website: https://doi.org/10.1007/s00464-025-11635-2
DCTERMS.abstract	Background: Hypoattenuated area (HA) formation at the pancreatojejunostomy (PJ) site on contrast-enhanced computed tomography (CE-CT) is significantly associated with clinically relevant postoperative pancreatic fistula (CR-POPF) after open pancreaticoduodenectomy (PD) (O-PD). Here, we evaluated the impact of HA formation in robotic PD (R-PD) and surgical factors predictive of HA formation. Methods: The study retrospectively analyzed 66 patients who underwent either O-PD or R-PD and exhibited a drain amylase level exceeding three times the upper limit of normal range, with CE-CT assessment performed on postoperative days 3–14. Patients were divided into two groups, with evident HA (≥ 5 mm) (E-HA) and subtle HA (< 5 mm) (S-HA), and their data were analyzed by multivariate and propensity-score matching analyses. Results: Among the patients, 24 (36.3%) exhibited E-HA and 42 (63.7%) S-HA. The percentages of R-PD and CR-POPF in E-HA group were significantly lower and higher, respectively, than S-HA group (R-PD: 29.2% vs 54.8%, p = 0.0446; CR-POPF: 70.8% vs 4.8%, p < 0.0001). Multivariate analysis revealed the surgical approach as a significant factor associated with E-HA formation (odds ratio: 0.26; p = 0.0223). Propensity-score matching analysis revealed significantly fewer patients with E-HA formation and CR-POPF in R-PD group than O-PD group (E-HA: 14.3% vs 64.3%, p = 0.0068; CR-POPF: 14.3% vs 57.1%, p = 0.0180). Conclusion: The impact of HA formation in predicting CR-POPF was confirmed in the patients undergoing PD, including O-PD and R-PD. Furthermore, the data suggest that R-PD, compared with O-PD, significantly decreased the incidence of E-HA formation, indicating an advantage of R-PD over O-PD in reducing CR-POPF via HA formation.
DC.rights	This article is licensed under a Creative Commons Attribution 4.0 International License.
DC.format	101005
citation_title	Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy
citation_author	Tomimaru, Yoshito
	Kobayashi, Shogo
	Sasaki, Kazuki
	Hasegawa, Shinichiro
	Yamada, Daisaku
	Akita, Hirofumi
	Noda, Takehiro
	Takahashi, Hidenori
	Imamura, Hiroki
	Doki, Yuichiro
	Eguchi, Hidetoshi
citation_publisher	Springer
citation_language	英語
citation_date	2025-04-01
citation_journal_title	Surgical Endoscopy
citation_volume	39
citation_issue	4
citation_firstpage	2561
citation_lastpage	2570
citation_doi	https://doi.org/10.1007/s00464-025-11635-2
citation_public_url	https://hdl.handle.net/11094/101005

Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy

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