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Laparoscopic pancreaticoduodenectomy reduces incidence of clinically relevant postoperative pancreatic fistula in soft pancreas with a smaller than 2 mm pancreatic duct

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Abstract

Background

Soft pancreas with small pancreatic duct is a known risk factor for postoperative pancreatic fistula (POPF). This study demonstrated the safety and feasibility of laparoscopic duct-to-mucosa pancreaticojejunostomy (PJ) and compared perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with soft pancreas and small pancreatic duct.

Methods

From January 2014 to December 2019, 183 patients underwent LPD and 91 patients underwent OPD by a single surgeon. Data on patients with soft pancreas and combined small pancreatic duct (≤ 2 mm) were retrospectively reviewed. Clinicopathologic characteristics, and perioperative outcomes were compared between LPD and OPD. We evaluated risk factors affecting clinically relevant POPF (CR-POPF). We also correlated calculated risks of POPF and CR-POPF between the two groups.

Results

We compared 62 patients in the LPD group and 34 patients in the OPD group. Perioperative outcomes showed less blood loss, shorter hospital stays, and less postoperative pain score on postoperative day (POD)#1 and #5 in LPD compared with OPD. Postoperative complications showed no differences between LPD and OPD. LPD group showed significantly reduced CR-POPF rates compared to the OPD group (LPD 11.3% vs. OPD 29.4%, p = 0.026). Multivariate analysis identified obesity (BMI ≥ 25), thick pancreas parenchyma and open surgery as independent predicting factors for CR-POPF. The LPD group showed less CR-POPF than the OPD group according to POPF risk groups. This difference was more prominent in a high-risk group.

Conclusion

With appropriate laparoscopic technique, LPD is feasible and safe and reduces CR-POPF in soft pancreas with a small pancreatic duct.

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Acknowledgments

Some part of these results were presented in the International Video Symposium-5 at the 70th General Meeting of the Japanese Society of Gastroenterological Surgery, in Hamamatsu, Japan, on July 15, 2015, and symposium 33- at the sixth Biennial Congress of the Asian-Pacific Hepato-Biliary-Pancreatic Surgery and the 29th Meeting of Japanese Society of Hepato-Biliary-Pancreatic Surgery, in Yokohama, Japan, on June 10 , 2017. The authors would like to express sincere thanks to Professor Katsuhiko Uesaka (Shizuoka Cancer Center), Satoshi Hirano (Hokkaido University), and Yoshiharu Nakamura (Nippon Medical School) for valuable comments and questions during that symposium, which were the basis for the discussion session in this manuscript. Authors also would like to express sincere thanks to Hera Kang for comprehensive narration in video materials.

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Author notes

  1. Seung Soo Hong and Jae Uk Chong have contributed equally as first authors.

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Ku, Seoul, 03722, Korea

    Seung Soo Hong, Ho Kyoung Hwang, Woo Jung Lee & Chang Moo Kang

  2. Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea

    Seung Soo Hong, Ho Kyoung Hwang, Woo Jung Lee & Chang Moo Kang

  3. Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea

    Jae Uk Chong

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  1. Seung Soo Hong
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Correspondence to Chang Moo Kang.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Also, all authors Seung Soo Hong, Jae Uk Chong, Ho Kyoung Hwang, Woo Jung Lee and Chang Moo Kang, the corresponding author have no conflict of interest.

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Hong, S.S., Chong, J.U., Hwang, H.K. et al. Laparoscopic pancreaticoduodenectomy reduces incidence of clinically relevant postoperative pancreatic fistula in soft pancreas with a smaller than 2 mm pancreatic duct. Surg Endosc 35, 7094–7103 (2021). https://doi.org/10.1007/s00464-020-08226-8

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