{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:52:28Z","timestamp":1790614348407,"version":"4.1.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T00:00:00Z","timestamp":1724371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To delineate the risk factors and causes of unplanned reoperations within 30 days following laparoscopic pancreaticoduodenectomy (LPD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study reviewed 311 LPD patients at Ningbo Medical Center Li Huili Hospital from 2017 to 2024. Demographic and clinical parameters were analyzed using univariate and multivariate analyses, with P &amp;lt; 0.05 indicating statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 311 patients, 23 (7.4%) required unplanned reoperations within 30 days post-LPD, primarily due to postoperative bleeding (82.6%). Other causes included anastomotic leakage, abdominal infection, and afferent loop obstruction. The reoperation intervals varied, with the majority occurring within 0 to 14 days post-surgery. Univariate analysis identified significant risk factors: diabetes, liver cirrhosis, elevated CRP on POD-3 and POD-7, pre-operative serum prealbumin &amp;lt; 0.15 g\/L, prolonged operation time, intraoperative bleeding &amp;gt; 120 ml, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter \u22643 mm (all P &amp;lt; 0.05). Multivariate analysis confirmed independent risk factors: pre-operative serum prealbumin &amp;lt; 0.15 g\/L (OR = 3.519, 95% CI 1.167-10.613), CRP on POD-7 (OR = 1.013, 95% CI 1.001-1.026), vascular reconstruction (OR = 9.897, 95% CI 2.405-40.733), soft pancreatic texture (OR = 5.243, 95% CI 1.628-16.885), and a main pancreatic duct diameter \u22643 mm (OR = 3.462, 95% CI 1.049-11.423), all associated with unplanned reoperation within 30 days post-LPD (all P &amp;lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Postoperative bleeding is the primary cause of unplanned reoperations after LPD. Independent risk factors, confirmed by multivariate analysis, include low pre-operative serum prealbumin, elevated CRP on POD-7, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter of \u22643 mm. Comprehensive peri-operative management focusing on these risk factors can reduce the likelihood of unplanned reoperations and improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1464450","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T08:35:50Z","timestamp":1724747750000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Causes and predictors of unplanned reoperations within 30 days post laparoscopic pancreaticoduodenectomy: a comprehensive analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Shiwei","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipesh Kumar","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaoqing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh Kumar","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yefan","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudi","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongfei","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00642443","article-title":"Laparoscopic pylorus-preserving pancreatoduodenectomy","volume":"8","author":"Gagner","year":"1994","journal-title":"Surg Endosc"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14259","article-title":"Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical-site wound infection: A meta-analysis","volume":"20","author":"Kong","year":"2023","journal-title":"Int Wound J"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.21037\/hbsn","article-title":"International expert consensus on laparoscopic pancreaticoduodenectomy*From The 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery, Wuhan, China","volume":"9","author":"Qin","year":"2020","journal-title":"Hepatobiliary Surg Nutr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12957-019-1624-6","article-title":"Laparoscopic pancreaticoduodenectomy: are the best times coming","volume":"17","author":"Liu","year":"2019","journal-title":"World J Surg Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1655668","DOI":"10.21037\/gs","article-title":"Perioperative and short-term oncological outcomes following laparoscopic versus open pancreaticoduodenectomy after learning curve in the past 10 years: a systematic review and meta-analysis","volume":"10","author":"Feng","year":"2021","journal-title":"Gland Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002893","article-title":"Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial","volume":"268","author":"Poves","year":"2018","journal-title":"Ann Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00054-6","article-title":"Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial","volume":"6","author":"Wang","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"323","DOI":"10.3390\/cancers16020323","article-title":"Minimally invasive pancreaticoduodenectomy in elderly versus younger patients: A meta-analysis","volume":"16","author":"Ballarin","year":"2024","journal-title":"Cancers"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199102073240605","article-title":"The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II","volume":"324","author":"Leape","year":"1991","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.136.4.405","article-title":"Is unplanned return to the operating room a useful quality indicator in general surgery","volume":"136","author":"Birkmeyer","year":"2001","journal-title":"Arch Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/0141076816643332","article-title":"The revised Declaration of Helsinki: cosmetic or real change","volume":"109","author":"Malik","year":"2016","journal-title":"J R Soc Med"},{"key":"B12","article-title":"American society of anesthesiologists classification","volume-title":"StatPearls","author":"Doyle","year":"2024"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.02.001","article-title":"Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.05.005","article-title":"Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.06.058","article-title":"Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery","volume":"161","author":"Besselink","year":"2017","journal-title":"Surgery"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2010.12.002","article-title":"Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery","volume":"149","author":"Koch","year":"2011","journal-title":"Surgery"},{"key":"B18","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s12893-020-00739-2","article-title":"Hypoalbuminemia after pancreaticoduodenectomy does not predict or affect short-term postoperative prognosis","volume":"20","author":"Xu","year":"2024","journal-title":"BMC Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s13193-021-01422-5","article-title":"Totally laparoscopic pancreaticoduodenectomy: comparison between early and late phase of an initial single-center learning curve","volume":"12","author":"Mazzola","year":"2021","journal-title":"Indian J Surg Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.4103\/jcrt.JCRT_137_19","article-title":"Risk factors for 30-day unplanned reoperation after pancreatoduodenectomy: A single-center experience","volume":"15","author":"Qiu","year":"2019","journal-title":"J Cancer Res Ther"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i37.5711","article-title":"Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis","volume":"25","author":"Zhang","year":"2019","journal-title":"World J Gastroenterol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.12.052","article-title":"Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors","volume":"220","author":"Dokmak","year":"2015","journal-title":"J Am Coll Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4269-z","article-title":"Postoperative bleeding after laparoscopic pancreaticoduodenectomy: the achilles\u2019 Heel","volume":"42","author":"Chopinet","year":"2018","journal-title":"World J Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"0300060520929127","DOI":"10.1177\/0300060520929127","article-title":"Management of late hemorrhage after pancreatic surgery: treatment strategy and prognosis","volume":"48","author":"Wu","year":"2020","journal-title":"J Int Med Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007500","article-title":"Efficacy of the prophylactic use of octreotide for the prevention of complications after pancreatic resection","volume":"96","author":"Wang","year":"2017","journal-title":"Med (Baltimore)"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.04.039","article-title":"Prealbumin improves death risk prediction of BNP-added Seattle Heart Failure Model: Results from a pilot study in elderly chronic heart failure patients","volume":"168","author":"Cabassi","year":"2013","journal-title":"Int J Cardiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12663-012-0376-4","article-title":"Efficacy of serum prealbumin and CRP levels as monitoring tools for patients with fascial space infections of odontogenic origin: A clinicobiochemical study","volume":"13","author":"Sharma","year":"2014","journal-title":"J Maxillofac Oral Surg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-018-0892-0","article-title":"CRP\/prealbumin, a novel inflammatory index for predicting recurrence after radical resection in gastric cancer patients: post hoc analysis of a randomized phase III trial","volume":"22","author":"Lu","year":"2019","journal-title":"Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1177\/0148607113499588","article-title":"Serum transthyretin level is associated with clinical severity rather than nutrition status in massively burned patients","volume":"38","author":"Yang","year":"2014","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"B31","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2021.638529","article-title":"Serum prealbumin concentrations, COVID-19 severity, and mortality: A systematic review and meta-analysis","volume":"8","author":"Zinellu","year":"2021","journal-title":"Front Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011740","article-title":"Low serum prealbumin levels on admission can independently predict in-hospital adverse cardiac events in patients with acute coronary syndrome","volume":"97","author":"Wang","year":"2018","journal-title":"Med (Baltimore)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2019.06.020","article-title":"Combination of postoperative C-reactive protein value and computed tomography imaging can predict severe pancreatic fistula after pancreatoduodenectomy","volume":"22","author":"Uchida","year":"2020","journal-title":"HPB"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1038\/s41598-020-58780-3","article-title":"Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery","volume":"10","author":"Messias","year":"2020","journal-title":"Sci Rep"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1191_20","article-title":"Role of serum C-reactive protein and interleukin-6 as a predictor of intra-abdominal and surgical site infections after elective abdominal surgery","volume":"10","author":"Hajong","year":"2021","journal-title":"J Fam Med Prim Care"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.hbpd.2022.04.006","article-title":"Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis","volume":"21","author":"Kokkinakis","year":"2022","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004855","article-title":"A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: A classification of the international study group of pancreatic surgery","volume":"277","author":"Schuh","year":"2023","journal-title":"Ann Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1464450\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T08:35:55Z","timestamp":1724747755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1464450\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,23]]},"references-count":37,"alternative-id":["10.3389\/fonc.2024.1464450"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1464450","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,23]]},"article-number":"1464450"}}