Surgical Selection And Clinical Correlation Analysis Of Segmental Pancreatectomy

Objective Segmental pancreatectomy,as an alternative to standardized operation,has been favored by both doctors and patients in recent years due to its ability to preserve better pancreatic endocrine and exocrine functions.This study will evaluate the safety and feasibility of robotic-assisted SP and establish a prediction model for the risk of diabetes mellitus deterioration after SP.Method The clinical data of patients who underwent three kinds of SP operation from January 2012 to June 2019 were analyzed retrospectively.After propensity score matching,these patients were compared with the robotic standardized operation and the corresponding open surgery.The risk factors of diabetic exacerbation after SP were screened by LASSO regression,and then validated by multivariate logistic regression.Finally,age,ASA score,preoperative diabetes status and pancreatic fistula were used as predictors to establish the nomogram.The accuracy and practicability of the nomogram were verified by calibration curve and decision curve.Result Compared with the standardized operation,RDP vs RMP showed significant difference in operation time(122.8 ± 45.1min vs.154.0 ± 54.5min;P < 0.001),blood loss(128.9 ± 196.4ml vs.75.6 ± 77.3ml;P = 0.004),and postoperative blood glucose(7.1 ± 1.8vs.6.4 ± 1.6;P = 0.002).Compared with open surgery,RMP vs.OMP showed significant differences in operation time(165.0 ± 65.1min vs.205.0 ± 56.8min;P < 0.001),blood loss(96.0 ± 99.5ml vs.183.3 ± 206.0ml;P = 0.001),and blood glucose(6.6 ± 1.5 vs.7.2 ± 1.9;P = 0.046).Calibration curves by internally validation showed good consistency with a Cindex of 0.824.Decision curves show that accepting the nomogram recommendations for surgical selection provides better benefit for patients.Conclusion Compared with standardized operation,robot SP can reduce the risk of longterm pancreatic endocrine dysfunction,but the incidence of postoperative complications is increased.Compared with the corresponding open surgery,robot SP could be performed with shorter operation time and less blood loss,which can reduce the trauma and promote rehabilitation.Regression analysis showed that age,ASA score,preoperative diabetes status and pancreatic fistula were independent risk factors for the deterioration of diabetes after SP.The nomogram based on these predictors has good prediction accuracy and patientbenefit rate,which can provide a reference for surgical selection by clinicians.