Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms
Abstract Background Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk facto...
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BMC
2025-07-01
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| Series: | World Journal of Surgical Oncology |
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| Online Access: | https://doi.org/10.1186/s12957-025-03920-0 |
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| author | Isheeta Madeka Steven Yi Julia Evans David Baek Haresh V. Naringrekar Harish Lavu Charles J. Yeo Avinoam Nevler Wilbur B. Bowne |
| author_facet | Isheeta Madeka Steven Yi Julia Evans David Baek Haresh V. Naringrekar Harish Lavu Charles J. Yeo Avinoam Nevler Wilbur B. Bowne |
| author_sort | Isheeta Madeka |
| collection | DOAJ |
| description | Abstract Background Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk factors associated with post-operative pancreatic fistulas (POPF) after pancreatic enucleation. Methods A two-tiered retrospective study was conducted. We identified 423 patients from TriNetX, and 34 patients from a single-institution IRB-approved database who underwent pancreatic enucleation between 2004–2025 and 2012–2023, respectively. Univariate and multivariate analyses were performed to determine risk factors associated with post-operative complications and occurrence of POPFs. Results In the TriNetX cohort, 128 (30.3%) experienced postoperative complications after pancreatic enucleation. On univariate analysis, hyperlipidemia (HLD) (OR = 2.37), gastroesophageal reflux disease (GERD) (OR = 3.87), acute pancreatitis (OR = 8.28), chronic pancreatitis (OR = 4.76), nicotine dependence (OR = 2.36), ascites (OR = 6.49), deep vein thrombosis (DVT), pulmonary embolism (PE), and thrombophlebitis (OR = 2.95), and body mass index (BMI) ≥ 25 (OR = 1.56) were identified as significant risk factors. On multivariate analysis, acute pancreatitis (HR = 1.64), chronic pancreatitis (HR = 1.78), ascites (HR = 2.96), DVT, PE and thrombophlebitis (HR = 1.74) remained significant. In our single-institution enucleation cohort, 8 patients had a POPF (23.5%). The measured distance from the neoplasm to the main pancreatic duct (MPD) was significantly shorter in patients who developed POPF (2.8 vs 6.5 mm, P < 0.05). ROC analysis determined that shorter distance from the MPD was predictive of POPF occurrence (AUC = 0.79, p < 0.005). Increased estimated blood loss was also associated with POPF (p < 0.01). Conclusion Our study identifies clinicopathologic risk factors associated with post-operative complications and POPF after pancreatic enucleation. The distance from the neoplasm to the MPD appears to be a key component of decision-making in the development of POPF. |
| format | Article |
| id | doaj-art-d937461ab8cd446187bf0bb97a4996b4 |
| institution | DOAJ |
| issn | 1477-7819 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj-art-d937461ab8cd446187bf0bb97a4996b42025-08-20T03:05:25ZengBMCWorld Journal of Surgical Oncology1477-78192025-07-0123111210.1186/s12957-025-03920-0Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasmsIsheeta Madeka0Steven Yi1Julia Evans2David Baek3Haresh V. Naringrekar4Harish Lavu5Charles J. Yeo6Avinoam Nevler7Wilbur B. Bowne8Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University HospitalSidney Kimmel Medical College, Thomas Jefferson UniversitySidney Kimmel Medical College, Thomas Jefferson UniversitySidney Kimmel Medical College, Thomas Jefferson University Department of Radiology, Thomas Jefferson University HospitalJefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University HospitalJefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University HospitalJefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University HospitalJefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson University HospitalAbstract Background Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk factors associated with post-operative pancreatic fistulas (POPF) after pancreatic enucleation. Methods A two-tiered retrospective study was conducted. We identified 423 patients from TriNetX, and 34 patients from a single-institution IRB-approved database who underwent pancreatic enucleation between 2004–2025 and 2012–2023, respectively. Univariate and multivariate analyses were performed to determine risk factors associated with post-operative complications and occurrence of POPFs. Results In the TriNetX cohort, 128 (30.3%) experienced postoperative complications after pancreatic enucleation. On univariate analysis, hyperlipidemia (HLD) (OR = 2.37), gastroesophageal reflux disease (GERD) (OR = 3.87), acute pancreatitis (OR = 8.28), chronic pancreatitis (OR = 4.76), nicotine dependence (OR = 2.36), ascites (OR = 6.49), deep vein thrombosis (DVT), pulmonary embolism (PE), and thrombophlebitis (OR = 2.95), and body mass index (BMI) ≥ 25 (OR = 1.56) were identified as significant risk factors. On multivariate analysis, acute pancreatitis (HR = 1.64), chronic pancreatitis (HR = 1.78), ascites (HR = 2.96), DVT, PE and thrombophlebitis (HR = 1.74) remained significant. In our single-institution enucleation cohort, 8 patients had a POPF (23.5%). The measured distance from the neoplasm to the main pancreatic duct (MPD) was significantly shorter in patients who developed POPF (2.8 vs 6.5 mm, P < 0.05). ROC analysis determined that shorter distance from the MPD was predictive of POPF occurrence (AUC = 0.79, p < 0.005). Increased estimated blood loss was also associated with POPF (p < 0.01). Conclusion Our study identifies clinicopathologic risk factors associated with post-operative complications and POPF after pancreatic enucleation. The distance from the neoplasm to the MPD appears to be a key component of decision-making in the development of POPF.https://doi.org/10.1186/s12957-025-03920-0PancreasNeoplasmsEnucleationParenchymal sparingPostoperativeFistula |
| spellingShingle | Isheeta Madeka Steven Yi Julia Evans David Baek Haresh V. Naringrekar Harish Lavu Charles J. Yeo Avinoam Nevler Wilbur B. Bowne Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms World Journal of Surgical Oncology Pancreas Neoplasms Enucleation Parenchymal sparing Postoperative Fistula |
| title | Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms |
| title_full | Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms |
| title_fullStr | Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms |
| title_full_unstemmed | Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms |
| title_short | Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms |
| title_sort | clinicopathologic risk factors for post operative complications after enucleation of pancreatic neoplasms |
| topic | Pancreas Neoplasms Enucleation Parenchymal sparing Postoperative Fistula |
| url | https://doi.org/10.1186/s12957-025-03920-0 |
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