Comparative Study Between Conservative Versus Surgical Management of Iatrogenic Pancreatic Injury During Radical...

Area of Science:

• Urology
• Surgical Oncology
• Gastroenterology

Background:

• Pancreatic injury is a rare but serious complication following radical nephrectomy.
• Optimal management strategies, conservative versus surgical, remain debated due to limited comparative data.

Purpose of the Study:

• To compare conservative management (CM) with surgical management (SM) for intraoperative pancreatic injuries during radical nephrectomy.
• Outcomes assessed include complications, hospital stay, and mortality.

Main Methods:

• Retrospective cohort study of 30 patients with intraoperative pancreatic injury during radical nephrectomy (Jan 2014 - Jan 2024).
• Group 1 (CM): 16 patients (drainage, nutritional support, somatostatin analogs).
• Group 2 (SM): 14 patients (repair, resection, drainage).

Main Results:

• Postoperative pancreatic fistula (POPF) was significantly less common in the surgical management group (14.3%) compared to the conservative management group (37.5%) (p=0.045).
• No significant difference in mortality rates between groups.
• Surgical management showed significant improvements in reduced hospital stay and failure/reintervention rates.

Conclusions:

• Surgical repair of pancreatic injury during radical nephrectomy is associated with a lower incidence of POPF and shorter hospital stays.
• Conservative management remains a viable option for minor pancreatic injuries.
• A risk-based approach is recommended for managing pancreatic injuries post-nephrectomy.