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Original article
Predictors of postoperative complications and readmissions in laparoscopic pancreas resection: Results of a cohort 105 consecutive cases. A retrospective study
Factores predictivos de complicaciones postoperatorias y reingresos en resecciones laparoscópicas de páncreas: resultados en una cohorte de 105 casos consecutivos. Estudio retrospectivo
Javier A. Cienfuegosa,
Corresponding author
fjacien@unav.es

Corresponding author.
, Luis Hurtado-Pardod, Charles E. Breezee, Francisco Guillenb,f, Víctor Valentia,b,c, Gabriel Zozayaa,b, Pablo Martía,b, Alberto Benitog, Fernando Pardoa,b, José Luis Hernández Lizoáina,b, Fernando Rotellara,b
a Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
b Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
c CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Spain
d Department of General Surgery, University and Polytechnic La Fe Hospital, Valencia, Spain
e UCL Cancer Institute, University College London, London WC1E 6BT, UK
f Department Preventive Medicine, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
g Department of Radiology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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        "afiliaciones" => array:7 [
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            "entidad" => "Department of General Surgery&#44; Cl&#237;nica Universidad de Navarra&#44; School of Medicine&#44; University of Navarra&#44; Pamplona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
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          1 => array:3 [
            "entidad" => "Institute of Health Research of Navarra &#40;IdisNA&#41;&#44; Pamplona&#44; Spain"
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            "entidad" => "CIBER Fisiopatolog&#237;a de la Obesidad y Nutrici&#243;n &#40;CIBERobn&#41;&#44; Instituto de Salud Carlos III&#44; Pamplona&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
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            "entidad" => "Department of General Surgery&#44; University and Polytechnic La Fe Hospital&#44; Valencia&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
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          4 => array:3 [
            "entidad" => "UCL Cancer Institute&#44; University College London&#44; London WC1E 6BT&#44; UK"
            "etiqueta" => "e"
            "identificador" => "aff0025"
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          5 => array:3 [
            "entidad" => "Department Preventive Medicine&#44; Cl&#237;nica Universidad de Navarra&#44; School of Medicine&#44; University of Navarra&#44; Pamplona&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
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          6 => array:3 [
            "entidad" => "Department of Radiology&#44; Cl&#237;nica Universidad de Navarra&#44; School of Medicine&#44; University of Navarra&#44; Pamplona&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
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        "titulo" => "Factores predictivos de complicaciones postoperatorias y reingresos en resecciones laparosc&#243;picas de p&#225;ncreas&#58; resultados en una cohorte de 105 casos consecutivos&#46; Estudio retrospectivo"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since its introduction in 1996 by Gagner and Pomp<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; laparoscopic resection of the pancreas &#40;LRP&#41; has been widely accepted in the treatment of benign lesions&#44; neuroendocrine tumors and malignant lesions located in the tail of the pancreas<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; apart from the well-known benefits of minimally invasive resections the technique has been implemented to a varying degree due to its technical difficulty&#44; the high rate of conversions to open surgery and the need for a long learning curve<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a>&#46; In the case of laparoscopic duodenopancreatectomy &#40;LDP&#41;&#44; after two favorable trials <a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a>&#44; a recent multi-center trial &#40;LEOPARD-2&#41; had to be suspended due to a higher incidence of postoperative complications in patients undergoing laparoscopy than open surgery<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The introduction of robot-assisted surgery offers a possible means of overcoming&#44; these limitations and currently there are three trials comparing open&#44; laparoscopic and robot-assisted LDPs<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is to analyze the factors associated with surgical complications and hospital readmissions in a cohort of 105 consecutive laparoscopic resections&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In our study we confirm that laparoscopic techniques meet the requirements of safety&#44; efficacy and efficiency<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Our analysis has allowed us to identify those pre-operative and intra-operative parameters which are associated with post-operative complications and hospital readmission&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Overview of study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective study was carried out using data from a prospective database of all consecutive patients undergoing laparoscopic resection of the pancreas between 2000 and 2020 in the Cl&#237;nica Universidad de Navarra&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was conducted following the STROCCS guidelines<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Patients gave their consent to participate in the study which was conducted following the latest version of the Declaration of Helsinki&#46; The study was approved by the Medial Ethics Committee and registered in the National Clinical Trial&#46;org &#40;<span class="elsevierStyleItalic">NCT04935216</span>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection and outcomes</span><p id="par0040" class="elsevierStylePara elsevierViewall">The following variables were extracted from the patients&#8217; electronic medical records&#58; age&#44; sex&#44; body mass index &#40;BMI&#44; calculated as weight in kilograms divided by height in meters squared&#41;&#44; American Society of Anesthesiology &#40;ASA&#41; score<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and the type of surgery<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The preoperative diagnosis was confirmed by at least two imaging tests and by endoscopic ultrasonography and fine needle aspiration &#40;FNA&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Duration of the surgery&#44; use of blood products&#44; intraoperative complications&#44; length of hospital stay and the size and histology of the tumor were all recorded&#46; Operative time &#40;minutes&#41; was defined as the time from first incision to final skin closure &#40;the last stich&#41;&#46; Length of hospital stay &#40;LOS&#41; was calculated from the day of surgery through and including the day of discharge&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Central pancreatectomy and DP were performed using the techniques described elsewhere<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a>&#46; In DP every attempt was made to spare the spleen and the splenic vessels using the technique of Kimura<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In DP&#44; intraabdominal drainage was avoided and was performed very selectively in CP and enucleations&#44; with the drain being removed on the third postoperative day<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Two authors&#44; &#40;JAC&#44; L H-P&#41; reviewed all the postoperative complications and classified them using the Clavien-Dindo classification<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; Complications were considered major when they were &#62; IIIb&#46; Pancreatic fistula&#44; postoperative bleeding and delay in gastric emptying were defined according to the International Study Group of Pancreatic Surgery &#40;ISGPS&#41;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Postoperative intraabdominal collection was defined as the accumulation of &#62;5 cm of fluid as indicated by CT scan or US<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Symptomatic collections or those associated with increases in inflammatory markers were drained via a nasogastric tube using endoscopic or percutaneous ultrasound<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Perioperative death was defined as death occurring in hospital or within 30 days of the operation&#46; Readmission was defined as an admission to any hospital for 24 h or more for any reason within 60 days of surgery&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Descriptive variables are presented as n &#40;percentages&#41; with confidence intervals and quantitative variables as means plus standard deviations or medians plus interquartile ranges where distribution of the data was not normal&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">For the comparison of categorical variables&#44; the Pearson Chi-squared test was used with the estimation of exact <span class="elsevierStyleItalic">P</span> values&#46; For the comparison of quantitative variables&#44; student t tests and ANOVA or their non-parametric equivalents the U-Mann&#8211;Whitney or Kruskal&#8211;Wallis tests were used&#46; Non-conditional multivariate logistic regression was used to determine the independent association between the variables studied and the development of postoperative complications or hospital readmission&#46; Multinomial logistic regression was performed adjusting for significant variables in the bivariate analysis&#58; age&#44; gender&#44; ASA score&#44; type of surgery and length of surgery&#46; Statistical significance was assessed at the 95th percentile&#46; <span class="elsevierStyleItalic">P</span> values &#60;&#46;05 were considered to be statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">Between January 2000 and October 2020&#44; 105 laparoscopic resections of the pancreas were performed&#44; of which 100&#37; were completed by the same surgeon &#40;FR&#41;&#46; There were no conversions to open surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the clinical&#44; surgical and histologic characteristics of the 105 patients&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Eighty-one &#40;77&#46;1&#37;&#41; DP were performed&#44; of which 41 &#40;50&#46;6&#37;&#41; were carried out with sparing of the spleen and splenic vessels &#40;Kimura procedure&#41; and one case of Warshaw technique&#46; Eighteen &#40;17&#46;1&#37;&#41; CP were performed&#44; 5 enucleations &#40;4&#46;8&#37;&#41; and one total pancreatectomy&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The most frequent indication was neuroendocrine tumors &#40;n &#61; 47&#59; 44&#46;8&#37;&#41;&#44; followed by cystic tumors of the pancreas &#40;n &#61; 39&#59; 37&#46;1&#37;&#41;&#46; The median operative time and hospital stay was 292 min &#40;range&#58; 218&#8211;357&#41; and 5&#46;7 days &#40;range 3&#8211;6&#41;&#44; respectively&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Abdominal drainage was left in place in 17 &#40;16&#46;1&#37;&#41; cases&#58; 10 &#40;55&#46;6&#37;&#41; in CP&#44; 5 &#40;6&#46;2&#37;&#41; in DP and 1 in enucleations &#40;20&#37;&#41; and total pancreatectomy&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patient-related factors associated with outcome</span><p id="par0110" class="elsevierStylePara elsevierViewall">Of the 105 patients&#44; 49 &#40;46&#46;6&#37;&#41;&#44; experienced some type of complication&#44; of which 43 &#40;41&#37;&#41; were minor or moderate and 13 &#40;12&#46;4&#37;&#41; major&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the analysis of the variables associated with the development of complications&#46; Age&#44; male gender&#44; ASA score&#44; CP and operative time were all significantly associated with a higher incidence of postoperative complications&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Given that CP was associated with a higher incidence of complications&#44; a comparison was made between CP and DP&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the univariate analysis of the complications from each type of surgery&#46; Grave complications&#44; the development of biochemical leak&#44; pancreatic fistula and the need to drain a postoperative intraabdominal collection were significantly more frequent in CP&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Twelve &#40;11&#46;4&#37;&#41; of the 104 patients &#40;excluding the single case of total pancreatectomy&#41; developed biochemical leak and 3 &#40;2&#46;8&#37;&#41; pancreatic fistula &#40;2 grade B and one grade C&#41;&#46; Thirty-eight patients &#40;36&#46;1&#37;&#41; developed intraabdominal fluid collections&#44; of which 28 &#40;3 in CP and 25 in DP&#41; were asymptomatic and resolved spontaneously with conservative treatment&#46; Ten patients developed symptomatic collections of which 8 required drainage&#58; 6 endoscopically &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; 1 percutaneously and 1 surgically&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Four patients &#40;3&#46;8&#37;&#41; experienced delay in gastric emptying &#40;grade A&#41; and 3 had extraluminal bleeding in the first 24 h after surgery&#44; of which 1 required repeat laparoscopic surgery&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In multivariate analysis ASA score was a risk factor for minor complications&#44; odds ratio &#40;OR&#41; 5&#46;52 &#40;95&#37; CI 2&#46;31&#8211;13&#46;15&#41; independently of type of surgery&#59; and central pancreatectomy was associated with major complications OR 7&#46;52 &#40;95&#37; CI 1&#46;73&#8211;32&#46;80&#41; regardless ASA status&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Eleven patients &#40;10&#46;5&#37;&#41; were readmitted in the first 30 days after surgery&#58; 9 for observation and the treatment of intraabdominal collections&#44; one for peripheral venous thrombosis and another with delayed gastric emptying&#46; The single patient death was due to massive bleeding secondary to the endoscopic drainage of a collection performed 10 days after the operation in the patient&#8217;s home town&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the multivariate analysis of the variables associated with hospital readmission&#46; Male gender&#44; OR 7&#46;97 &#40;95&#37; CI&#44; 1&#46;08&#8211;58&#46;88&#41;&#44; grave complications OR 59&#46;40&#44; &#40;95&#37; CI&#44; 7&#46;97&#8211;458&#46;99&#41; and intraabdominal fluid collections OR 8&#46;97&#59; &#40;95&#37; CI&#44; 1&#46;28&#8211;63&#46;02&#41; were associated with hospital readmission&#46; However&#44; no association was found with delay in gastric emptying&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Minimally invasive pancreatic resections have rapidly gained acceptance in the treatment of tumors which are benign or have low-grade malignancy&#44; especially in resections which spare the pancreatic parenchyma&#58; central&#44; distal pancreatectomies and enucleations<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;5</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In our series&#44; most of the pancreatic resections were central or distal and as such the phenotype of the patients coincides with the published series in this type of resections<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Although the most frequent tumors were neuroendocrine &#40;47&#46;4&#37;&#41;&#44; we performed only 5 enucleations &#40;4&#46;8&#37;&#41; given the high incidence of pancreatic fistula reported with this procedure<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">All the surgeries were performed laparoscopically and by the same surgeon &#40;FR&#41;&#44; with no conversions to open surgery&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Operative time was slightly longer than that reported in extensive multicenter series and systematic reviews&#44; perhaps due to the greater complexity of the procedures performed &#40;CP&#44; sparing of the spleen and splenic vessels&#41;&#44; the systematic use of intraoperative ultrasound and meticulous hemostasis avoiding the use of harmonic scalpels &#40;high-energy sealant devices&#41;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;31</span></a>&#46; In our series the duration of the operation was not considered <span class="elsevierStyleItalic">a priori</span> a reason to convert to open surgery in spite of the reported association between operative time and postoperative complications<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The median hospital stay for minimally invasive CP was shorter than that reported in other studies<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#44; while in the minimally invasive DP it was similar to that reported by Van Buren et al and Weber et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;34</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Most complications were minor &#40;Clavien-Dindo &#60; IIIb&#41;&#44; and we noted that male gender&#44; age&#44; ASA score&#44; type of surgery &#40;CP vs DP&#41; and operative time were significantly associated with the development of postoperative complications<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Age and ASA score reflect the patient&#8217;s baseline performance status and homeostatic ability to respond to the surgery<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Operative time was also a factor predictive of postoperative complications&#46; Apart from reflecting technical difficulty&#44; operative time has been linked to greater stimulation of the innate immune system&#44; secondary to the greater tissue damage<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In our series CP was associated with more postoperative complications than DP&#44; which reflects the greater technical complexity of this procedure<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;16</span></a>&#46; Apart from the longer operative time&#44; CP requires a pancreato-enteric anastomosis&#44; with the consequent risk postoperative fistula&#46; The three pancreatic fistulas &#40;2 grade B and one grade C&#41; occurred in CP&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The experience reported in minimally invasive laparoscopic CP is limited to small series<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46; In our series of minimally invasive CP &#40;18 cases&#41;&#44; hospital stay &#40;median of 5 days&#41; and incidence of pancreatic fistula &#40;16&#46;6&#37;&#41; were similar to those reported in series with more than 15 cases&#44; with the limitations cited above<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In our series there were 3 &#40;2&#44;8&#37;&#41; pancreatic fistulas &#40;2 grade B and one grade C&#41;&#44; a number that is lower than that reported in CP &#40;15&#37;&#8211;40&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;36</span></a> and DP &#40;15&#37;&#8211;20&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In line with previous studies&#44; we avoided systematically leaving abdominal drains in place in DP used them only selectively in CP and removed them in the first three days after surgery<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;37</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Apart from the comments above&#44; we believe that one of the factors for the low incidence of pancreatic fistula is sparing the integrity of the arterial vascularization of the remnant pancreas&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Furthermore&#44; most resections were DP &#40;n &#61; 81&#59; 77&#46;1&#37;&#41;&#44; which do not require pancreatojejunal anastomosis and only 5 enucleations &#40;4&#46;8&#37;&#41; were performed for the reasons previously mentioned<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">However&#44; we observed 38 pancreatic collections&#44; which were mostly asymptomatic&#44; and which resolved with conservative treatment&#46; We are aware that the advantages of not leaving the drain in place have to weighed against the diagnostic and therapeutic dilemma of postsurgical peripancreatic collections&#44; which may have been considered as &#8220;biochemical leaks&#8221; had they been drained<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Twenty-eight patients &#40;28&#46;3&#37;&#41; developed asymptomatic intraabdominal collections&#58; 3 &#40;16&#46;6&#37;&#41; in CP and 25 &#40;30&#46;9&#37;&#41; in minimally invasive DP&#46; The incidence of collections in DP is similar to that reported by other studies in which intraperitoneal drains were not left in place and higher than those reported in studies where drains were systematically left in place<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Of the 31 cases of acute fluid collection &#40;AFC&#41; in DP&#44; 4 &#40;12&#46;9&#37;&#41; patients required endoscopic drainage&#44; a figure similar to that of the studies previously cited<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;25</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">A great deal of variability in the incidence of AFC has been reported due to the diversity of the criteria for definition&#44; the use of US in the postoperative period and the type of surgery<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;37</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">In agreement with other authors&#44; we believe that asymptomatic collections should not be drained<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> or should be only in the presence of symptoms&#46; This policy requires strict monitoring of patients and the availability of endoscopists skilled in transgastric drainage<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; The only death was due to endoscopic drainage of an intraabdominal collection in another hospital&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Given that many of the parameters related to complications are known in the preoperative period&#44; they are of great practical value when it comes to assigning resources &#40;previous experience of the surgeon&#44; estimation of operative time&#41; aimed at reducing complications&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">In our series&#44; there were 11 &#40;10&#37;&#41; hospital readmissions&#44; of which 9 were due to the treatment of intraabdominal collections&#46; These figures are similar to those reported by Kamarajah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#44; although this study refers basically to pancreato-duodenectomies&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">In the multivariate analysis&#44; we found three variables that were associated with hospital readmission&#58; male gender&#44; severe complications and intraabdominal collections&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Since the first report of laparoscopic duodenopancreatectomy &#40;LDP&#41; by Gagner and Pomp<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1994&#44; minimally invasive resection of the pancreas has progressively become more widely implemented and accepted<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;5</span></a>&#46; The well-known advantages of laparoscopic surgery must be weighed against its disadvantages which include its technical difficulty&#44; the high rate of conversions to open surgery and the need for a long learning curve &#40;80&#8211;100 cases for LDP&#44; 40 cases for LDP&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;41</span></a>&#44; as a result of which the degree of implementation of the technique is very varied and the dilemma of concentrating this type of surgery in centers with a high volume of patients arise<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a>&#46; Despite recognition of the volume-outcome relationship&#44; in our region pancreas surgery is not centralized<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Laparoscopic resections are the ideal technique for the treatment of neuroendocrine tumors&#44; cystic tumors and malign tumors located in the tail of the pancreas<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; However&#44; the use of laparoscopic duodenopancreatectomy &#40;LDP&#41;&#44; is controversial as a higher incidence of complications has been recorded in a recent multi-center trial &#40;LEOPARD-2&#41;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;41</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">The introduction of robot-assisted surgery has provided a potential means to overcome these limitations and currently three trials comparing open&#44; laparoscopic and robot-assisted LDPs are ongoing<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0270" class="elsevierStylePara elsevierViewall">There are some limitations that must be taken into account when assessing results as it is a limited series of cases &#40;n &#61; 105&#41; with lesions generally located in the distal pancreas and that all the patients were operated on by the same surgeon&#44; which may bias the comparison with results from other centers&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">In addition&#44; the study covers a long period of time in which improvements were made in surgical techniques and perioperative care&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">However&#44; as it is a single center study&#44; it avoids the great variability that is observed in large multicenter series both in surgical technique and the early diagnosis and treatment of complications&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0285" class="elsevierStylePara elsevierViewall">Central and distal resections of the pancreas performed laparoscopically are safe and offer the advantages inherent in minimally invasive surgery&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Male gender&#44; age&#44; ASA score&#44; operative time and central pancreatectomy are associated with the development of postoperative complications&#46; Similarly&#44; male gender&#44; the occurrence of severe complications and intraabdominal fluid collections are associated with higher readmission rates&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0295" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial or not-for-profit sectors&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Author contributions</span><p id="par0300" class="elsevierStylePara elsevierViewall">JAC&#44; L H-P&#44; and FR conceived and designed the research question&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">JAC and L H-P prepared the data for analysis&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">JAC&#44; L H-P&#44; CEB and FG analyzed the data&#46; All authors had full access to all data in the study and had final responsibility for the decision to submit for publication&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">JAC and L H-P wrote the first draft of the manuscript&#46; All authors provided input on interpretation of results&#46; All authors revised the manuscript critically for important intellectual content and read and approved the final manuscript&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0320" class="elsevierStylePara elsevierViewall">The authors are not aware of any affiliations&#44; membership&#44; funding&#44; or financial holdings that might be perceived as affecting the objectivity of this manuscript&#46;</p></span></span>"
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    "fechaRecibido" => "2021-11-04"
    "fechaAceptado" => "2022-04-14"
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            0 => "Laparoscopia"
            1 => "M&#237;nimamente invasiva"
            2 => "Pancreatectom&#237;a distal"
            3 => "Pancreatectom&#237;a central"
            4 => "Complicaci&#243;n"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic resection of the pancreas &#40;LRP&#41; has been implemented to a varying degree because it is technically demanding and requires a long learning curve&#46; In the present study we analyze the risk factors for complications and hospital readmissions in a single center study of 105 consecutive LRPs&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective study using a prospective database&#46; Data were collected on age&#44; gender&#44; BMI&#44; ASA score&#44; type of surgery&#44; histologic type&#44; operative time&#44; hospital stay&#44; postoperative complications&#44; degree of severity and hospital readmission&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The cohort included 105 patients&#44; 63 females and 42 males with a median age and BMI of 58 &#40;53&#8211;70&#41; and 25&#46;5 &#40;22&#44;2&#8211;27&#46;9&#41; respectively&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Eighteen &#40;17&#37;&#41; central pancreatectomies&#44; 5 &#40;4&#46;8&#37;&#41; enucleations&#44; 81 &#40;77&#46;6&#37;&#41; distal pancreatectomies and one total pancreatectomy were performed&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Fifty-six patients &#40;53&#46;3&#37;&#41; experienced some type of complication&#44; of which 13 &#40;12&#46;3&#37;&#41; were severe &#40;Clavien-Dindo &#62; IIIb&#41; and 11 &#40;10&#46;5&#37;&#41; patients were readmitted in the first 30 days after surgery&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">In the univariate analysis&#44; age&#44; male gender&#44; ASA score&#44; central pancreatectomy and operative time were significantly associated with the development of complications &#40;<span class="elsevierStyleItalic">P</span> &#60;0&#46;05&#41;&#46; In the multivariate analysis&#44; male gender &#40;OR 7&#46;97&#59; 95&#37; CI 1&#46;08&#8211;58&#46;88&#41;&#41;&#44; severe complications &#40;OR 59&#46;40&#59; 95&#37; CI&#44; 7&#46;69&#8211;458&#46;99&#41;&#44; and the development of intrabdominal collections &#40;OR 8&#46;97&#59; 95&#37; CI&#44; 1&#46;28&#8211;63&#46;02&#41;&#41; were associated with hospital readmission&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Age&#44; male gender&#44; ASA score&#44; operative time and central pancreatectomy are associated with a higher incidence of complications&#46; Male gender&#44; severe complications and intraabdominal collections are associated with more hospital readmissions&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Las resecciones laparosc&#243;picas del p&#225;ncreas &#40;RLP&#41; tienen un grado de implantaci&#243;n muy heterog&#233;neo debido a su dificultad t&#233;cnica y a exigir una curva de aprendizaje larga&#46; En el presente trabajo estudiamos los factores de riesgo de las complicaciones y de los reingresos en una serie unic&#233;ntrica de 105 RLP&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio retrospectivo&#46; Se recogieron la edad&#44; sexo&#44; &#237;ndice de masa corporal&#44; el grado ASA&#44; tipo de cirug&#237;a&#44; tipo histol&#243;gico&#44; duraci&#243;n de la intervenci&#243;n&#44; estancia hospitalaria&#44; las complicaciones postoperatorias&#44; grado de gravedad y reingreso&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La cohorte comprende 105 pacientes&#44; 63 mujeres y 42 varones&#44; con una mediana de edad y IMC&#44; de 58 &#40;53&#8211;70&#41; y 25&#46;5 &#40;22&#46;2&#8211;25&#46;5&#41; respectivamente&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 18 &#40;17&#37;&#41; pancreatectomias centrales&#44; 81 &#40;77&#37;&#41; distales&#44; 5 &#40;4&#46;8&#37;&#41; enucleaciones y una total&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">56 &#40;53&#46;3&#37;&#41; pacientes sufrieron alguna complicaci&#243;n&#44; 13 &#40;12&#46;3&#37;&#41; fueron graves &#40;Clavien-Dindo &#62; IIIb&#41; y hubo 11 &#40;10&#46;5&#37;&#41; reingresos&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">En el an&#225;lisis univariante&#44; la edad&#44; el sexo masculino&#44; el grado ASA&#44; la pancreatectom&#237;a central y el tiempo operatorio se asociaban significativamente con el desarrollo de complicaciones &#40;P &#60; 0&#46;05&#41;&#46; En el an&#225;lisis multivariante&#44; los varones &#40;OR 7&#46;97&#59; 95&#37; IC 1&#46;08&#8211;58&#46;8&#41;&#44; las complicaciones severas &#40;OR 59&#46;40&#59; 95&#37; IC 7&#46;69&#8211;458&#46;9&#41;&#44; el desarrollo de colecciones intraabdominales &#40;OR 8&#46;97&#59; 95&#37; IC 1&#46;2&#8211;63&#46;0&#41; se asociaban con el reingreso hospitalario&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">La edad&#44; el sexo masculino&#44; el grado ASA&#44; la duraci&#243;n de la intervenci&#243;n y la pancreatectom&#237;a central se asocian con mayor incidencia de complicaciones&#46; Los varones&#44; las complicaciones graves&#44; las colecciones intraabdominales se asociaban con m&#225;s reingresos hospitalarios&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan showing an infected retrogastric fluid collection &#40;10 cm diameter&#41; that developed 14 days after central pancreatectomy&#46; The collection was successfully drained by endoscopic ultrasound with two Double pigtail plastic stents &#40;8&#46;5 and 10 french&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ASA&#44; American Society of Anesthesiologists&#59; BMI&#44; body mass index &#40;calculated as weight in kilograms divided by height in meters squared&#41;&#59; IQR&#44; interquartile range&#46;</p>"
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                  \t\t\t\t">42 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">I &#40;healthy status&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">II &#40;mild systemic disease&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;48&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">III &#40;severe systemic disease&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;43&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">IV &#40;incapacitating disease&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Diabetes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tumor site</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Head</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Body</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;22&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tail</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;73&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Difuse</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Type of resection&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enucleation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Central pancreatectomy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;17&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Distal pancreatectomy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;77&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#9724; With splenectomy&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;48&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#9724; Spleen-preserving procedure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;51&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#9675; Splenic vessel preservation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;50&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#9675; Warshaw technique&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Total pancreatectomy&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Operative time&#44; median &#40;IQR&#41;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">min</span></span><span class="elsevierStyleBold">&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">292 &#40;218&#8211;357&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tumor diameter&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3 &#40;12&#8211;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Histopathological diagnosis&#44; n&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neuroendocrine tumor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;44&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Serous cystoadenoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mucinous cystic neoplasm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;17&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intraductal papillary mucinous neoplasm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Solid-pseudopapillary neoplasm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pancreatic ductal adenocarcinoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;10&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Length of hospital stay&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">d</span></span><span class="elsevierStyleBold">&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;7 &#40;3&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">13 &#40;12&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&#44; 63 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;mean&#44; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#46;7 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63&#46;8 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#46;1 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;014<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;n &#61; 103&#41; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">24&#46;3 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;6 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&#44; 42 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;8 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#46;2 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#46;9 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&#44; 63 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Global&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">268&#46;5 &#40;98&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">355&#46;5 &#40;115&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;017<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Central&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">376&#46;4 &#40;91&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">268&#46;2 &#40;94&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">280&#46;7 &#40;85&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col">Overall n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#61; 99 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;38&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Clavien-Dindo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">I&#8211;IIIa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;38&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;27&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;40&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805;IIIb</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;13&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Fluid collection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;62&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;61&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;61&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Asymptomatic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;28&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;30&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Symptomatic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;10&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Treatment conservative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Endoscopic drainage</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Percutaneous drainage</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgical</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Postoperative fistula</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;84&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;44&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;93&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Biochemical leak</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;12&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;38&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;IIIa&#44; n &#61; 92&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#46;40 &#40;7&#46;69&#8211;458&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Collection</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&#44; n &#61; 37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#46;96 &#40;1&#46;75&#8211;27&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#46;08 &#40;1&#46;56&#8211;232&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;97 &#40;1&#46;28&#8211;63&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Delayed gastric emptying</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;73 &#40;0&#46;25&#8211;28&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">26&#46;85 &#40;0&#46;65&#8211;1106&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735077
Original language: English
DOI:10.1016/j.cireng.2022.04.015
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WITHDRAWN: Moderators analysis in meta-analysis:...
Cir Esp. 2024;102:389-90

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