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. 2025 Jun 13;17(6):e85895.
doi: 10.7759/cureus.85895. eCollection 2025 Jun.

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

Ayman Abdulmohaymen  1 , Abd Elfattah Al Sheikh  1 , Tamer A Ali  2 , Mohamed Rehan  3 , Saed Khater  3 , Esam A Elnady  3 , Maha M Elzamek  2 , Osama M Ghoneimy  2 , Mohamed F Elebiary  2 , Mohamed Hindawy  4 , Ahmed M Aydarous  1 , Satyabrata Garanayka  5 , Ahmed Youssef  1 , Khaled Monazea  6 , Abdoh Salem  7 , Ahmed Lamey  8
Affiliations

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

Ayman Abdulmohaymen et al. Cureus. .

Abstract

Background Pancreatic injury is a rare but serious complication of radical nephrectomy. The best management strategy for this complication, either conservative or surgical, remains debated, with limited comparative data. Objective To compare conservative management (CM) (drain placement, nutritional support, or somatostatin analogs) with surgical management (SM) (direct pancreatic repair, surgical drainage procedures, or partial pancreatectomy) in terms of outcomes, hospital stay, and mortality. Patients and methods A retrospective cohort study was conducted, including 30 patients who underwent radical nephrectomy with intraoperative pancreatic injury from January 2014 to January 2024. Patients were divided into two groups: Group 1, the CM group, which had 16 patients who underwent percutaneous drainage, octreotide, or enteral nutrition, and group 2, the SM group, which had 14 patients who underwent pancreatic repair, resection, or internal drainage. Both groups were compared in terms of complications, hospital stay, and mortality. Results The study groups were comparable regarding baseline patient criteria. Postoperative pancreatic fistula (POPF) was markedly less common in group 2 (14.3%; 2/14) than group 1 (37.5%; 6/16) (p=0.045). Mortality rates did not significantly differ between the trial arms. However, secondary outcomes revealed statistically significant differences between study groups in terms of hospital stay and failure/reintervention rates. Conclusion Surgical repair reduces POPF incidence and hospital stay, but CM is effective in minor injuries. A risk-based approach is recommended.

Keywords: conservative management; pancreatic fistula; pancreatic injury; radical nephrectomy; surgical management.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of Al-Azhar Faculty of Medicine issued approval (IRB 10/2024). Protocols and written informed consent for all participants were approved by ethical committee of Al-Azhar Faculty of Medicine under the Institutional Review Board (IRB 10/2024). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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