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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1464450

Causes and Predictors of Unplanned Reoperations Within 30 Days Post Laparoscopic Pancreaticoduodenectomy: A Comprehensive Analysis

Provisionally accepted
Shiwei Zhang Shiwei Zhang 1Dipesh K. Yadav Dipesh K. Yadav 2,3*Gaoqing Wang Gaoqing Wang 1Yin Jiang Yin Jiang 1Jie Zhang Jie Zhang 1Rajesh Kumar Yadav Rajesh Kumar Yadav 4Alina Singh Alina Singh 5Guo Gao Guo Gao 1Junyu Chen Junyu Chen 1Yefan Mao Yefan Mao 1Chengwei Wang Chengwei Wang 1Yudi Meng Yudi Meng 1Yongfei Hua Yongfei Hua 1
  • 1 Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Centre Li Huili Hospital, Ningbo, Zhejiang Province, China
  • 2 Department of General Surgery, Wenzhou People's Hospital, The Third Clinical Institute Affiliated to Wenzhou Medical University; and The Third Affiliated Hospital of Shanghai University, Wenzhou, China
  • 3 School of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, Jiangsu Province, China
  • 4 College of Pharmacy, University of Louisiana at Monroe, Monroe, Connecticut, United States
  • 5 Department of Surgery, Parkland Medicare and Research Center., Janakpur, Nepal

The final, formatted version of the article will be published soon.

    To delineate the risk factors and causes of unplanned reoperations within 30 days following laparoscopic pancreaticoduodenectomy (LPD).A retrospective study reviewed 311 LPD patients at Ningbo Medical Center Li Huili Hospital from 2017 to 2024. Demographic and clinical parameters were analyzed using univariate and multivariate analyses, with P < 0.05 indicating statistical significance.Out of 311 patients, 23 (7.4%) required unplanned reoperations within 30 days post-LPD, primarily due to postoperative bleeding (82.6%). Other causes included anastomotic leakage, abdominal infection, and afferent loop obstruction. The reoperation intervals varied, with the majority occurring within 0 to 14 days post-surgery. Univariate analysis identified significant risk factors: diabetes, liver cirrhosis, elevated CRP on POD-3 and POD-7, pre-operative serum prealbumin < 0.15 g/L, prolonged operation time, intraoperative bleeding > 120 ml, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter ≤3 mm (all P < 0.05). Multivariate analysis confirmed independent risk factors: pre-operative serum prealbumin < 0.15 g/L (OR = 3.519, 95% CI 1.167-10.613), CRP on POD-7 (OR = 1.013, 95% CI 1.001-1.026), vascular reconstruction (OR = 9.897, 95% CI 2.405-40.733), soft pancreatic texture (OR = 5.243, 95% CI 1.628-16.885), and a main pancreatic duct diameter ≤3 mm (OR = 3.462, 95% CI 1.049-11.423), all associated with unplanned reoperation within 30 days post-LPD (all P < 0.05).Postoperative bleeding is the primary cause of unplanned reoperations after LPD. Independent risk factors, confirmed by multivariate analysis, include low pre-operative serum prealbumin, elevated CRP on POD-7, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter of ≤3 mm.Comprehensive peri-operative management focusing on these risk factors can reduce the likelihood of unplanned reoperations and improve patient outcomes.

    Keywords: Pancreatic tumor, Laparoscopic pancreaticoduodenectomy, Unplanned reoperation, Risk factors, Postoperative Hemorrhage

    Received: 14 Jul 2024; Accepted: 30 Jul 2024.

    Copyright: © 2024 Zhang, Yadav, Wang, Jiang, Zhang, Yadav, Singh, Gao, Chen, Mao, Wang, Meng and Hua. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Dipesh K. Yadav, Department of General Surgery, Wenzhou People's Hospital, The Third Clinical Institute Affiliated to Wenzhou Medical University; and The Third Affiliated Hospital of Shanghai University, Wenzhou, China

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