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

Number of Access:1,505（2025-07-19 21:02 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/101005

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Title	Impact of a robotic approach on hypoattenuated area formation leading to postoperative pancreatic fistula in patients after pancreatoduodenectomy
Creator	NRID 1000070528570 1000070528570 researchmap permalink yoshitotomimaru yoshitotomimaru Scopus Author ID 10240341100 10240341100 CreatorName Tomimaru, Yoshito
	NRID 1000030452436 1000030452436 CreatorName Kobayashi, Shogo
	NRID 1000020745442 1000020745442 researchmap permalink Kazuki_Sasaki Kazuki_Sasaki Scopus Author ID 56087041900 56087041900 CreatorName Sasaki, Kazuki
	NRID 1000060621026 1000060621026 CreatorName Hasegawa, Shinichiro
	NRID 1000060571396 1000060571396 ORCID 0000-0002-6702-3800 0000-0002-6702-3800 researchmap permalink dyamada79222 dyamada79222 Scopus Author ID 37008067700 37008067700 CreatorName Yamada, Daisaku
	NRID 1000070528463 1000070528463 researchmap permalink hirofumi_akita hirofumi_akita CreatorName 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 CreatorName 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 CreatorName Takahashi, Hidenori
	ORCID 0000-0001-5363-0661 0000-0001-5363-0661 CreatorName Imamura, Hiroki
	NRID 1000020291445 1000020291445 researchmap permalink ydoki3251 ydoki3251 Scopus Author ID 7006390687 7006390687 CreatorName Doki, Yuichiro
	NRID 1000090542118 1000090542118 researchmap permalink abcdabcdabcd abcdabcdabcd Scopus Author ID 7101627772 7101627772 CreatorName Eguchi, Hidetoshi
Subject	Hypoattenuated area
	Pancreatic fistula
	Pancreaticoduodenectomy
	Pancreatojejunostomy
	Robotic pancreaticoduodenectomy
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
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.
Publisher	Springer
Source Title	Surgical Endoscopy
Volume (Issue)	39(4)
Page	2561-2570
Date of Issued	2025-04-01
Language	English
Handle URL	https://hdl.handle.net/11094/101005
PISSN	09302794
eISSN	14322218
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1007/s00464-025-11635-2
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
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	English
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	English
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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