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Pancreaticojejunostomy without pancreatic duct stent after laparoscopic pancreatoduodenectomy: preliminary outcomes from a prospective randomized controlled trial

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Abstract

Background

Outcomes of pancreaticojejunostomy without pancreatic duct during open pancreaticoduodenectomy (OPD) are unknown and controversial, and corresponding reports in laparoscopic surgery are lacking.

Methods

Patients were evaluated at West China Hospital, and standard laparoscopic pancreaticoduodenectomy (LPD) was planned. A prospective randomized trial was conducted, in which the patients were randomly assigned to the no-stent and internal-stent groups in a single-center trial. The primary outcomes were the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and 90-day mortality. Preliminary results were reported.

Results

From November 2019 to March 2021, we enrolled 90 patients (41 in the no-stent group and 49 in the internal-stent group) in the study. All baseline parameters of both groups, including age, sex ratio, pancreatic duct diameter, and intraoperative blood loss, were comparable between the two groups except for pathological diagnosis and the texture of remnants. Twenty-seven (65.9%) and 19 (38.8%) patients in the no-stent and internal-stent groups, respectively, had soft pancreatic remnants (P = 0.010). The total incidence of CR-POPF was 5.6% and included two patients (4.9%) in the no-stent group and three patients (6.1%) in the internal-stent group (P = 1.000). Only one patient in the internal-stent group died of heart failure within 90 days after the operation. No significant difference in other postoperative complications was observed between the groups except for biochemical fistula [no-stent group vs. internal-stent group = 31.7% vs. 12.2%, (P = 0.024)].

Conclusions

In a high-volume LPD center, duct-to-mucosa pancreaticojejunostomy without pancreatic duct stent is safe and reliable. In addition, duct-to-mucosa pancreaticojejunostomy without pancreatic duct stent was more challenge. We recommend using the stent during anastomosis and pulling it out after the procedure.

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Funding

This study was funded by the National Institutes of Health of China (W2017ZWS07).

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Author notes

  1. He Cai and Fei Lu contributed equally to this work. They are co-first authors.

Authors and Affiliations

  1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    He Cai, Yunqiang Cai, Xin Wang & Bing Peng

  2. Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China

    He Cai, Man Zhang, Yunqiang Cai, Yongbin Li, Lingwei Meng & Pan Gao

  3. The Health Management Center of West China Hospital, Sichuan University, Chengdu, China

    Fei Lu

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  1. He Cai
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  5. Xin Wang
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Contributions

Conceived and designed the study: HC, FL, XW, YC, BP; Performed the study and surgery: BP, YC, PG, HC, YL and LM; Enrolled patients: MZ; Collected and analyze the data: FL and XW; Wrote the paper: HC, FL and MZ; Video Clip: FL, PG, HC; Final approval of the version to be published: All authors.

Corresponding author

Correspondence to Bing Peng.

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Disclosures

Dr. He Cai, Fei Lu, Man Zhang, Yunqiang Cai, Xin Wang, Yongbin Li, Lingwei Meng, Pan Gao and Bing Peng have no conflicts of interest or financial ties to disclose.

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Cai, H., Lu, F., Zhang, M. et al. Pancreaticojejunostomy without pancreatic duct stent after laparoscopic pancreatoduodenectomy: preliminary outcomes from a prospective randomized controlled trial. Surg Endosc 36, 3629–3636 (2022). https://doi.org/10.1007/s00464-021-08909-w

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