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Prospective cohort study on short-term outcomes of 3D-laparoscopic pancreaticoduodenectomy with stented pancreaticogastrostomy

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Abstract

Background

Minimally invasive pancreaticoduodenectomy, either laparoscopic or robotic, is a high-risk procedure with demanding learning curve. The aim of this prospective cohort study was to evaluate short-term clinical and oncologic outcomes of 3D-laparoscopic pancreaticoduodenectomy (3dLPD) with stented pancreaticogastrostomy (sPG) and Roux-en-Y gastroenterostomy (ryGES).

Methods

Between March 2016 and July 2021, 347 consecutive patients underwent 3dLPD for confirmed or suspected pancreatic or periampullary tumors. Pancreatic duct diameter measured 3 mm or less in 221 (64%) and pancreatic texture was soft in 191 (55%) patients. Simultaneous resection of the superior mesenteric or portal vein was performed in 52 (15%) patients.

Results

Postoperative complications were observed in 189 (54%) patients, with severe complications (Clavien–Dindo grade > 2) in 68 (20%) including 4 (1.2%) deaths. Clinically relevant pancreatic fistula (cPOPF) occurred in 88 (25%), hemorrhage in 25 (7%), and bile leakage in 10 (3%) patients. Clinical pancreatic fistula was strongly associated with soft pancreatic texture and small pancreatic duct diameter (p < 0.001) and managed by endoscopic trans-gastric drainage in 34 (38.6%) patients, reoperation in 12 (13.6%), and ICU admission in 11 (12.5%). The remaining 31 (35%) patients with cPOPF were managed without invasive intervention. Median length of hospital stay after surgery was 13 (range 5–112; IQR 8–18) days. In pancreatic adenocarcinoma (PDAC) the R0-resection rate was 66/186 (36%), R1-indirect 95/186 (51%), and R1-direct 25 (13%). Median number of locoregional lymph nodes retrieved in PDAC was 21 (IQR 15–28). R0-resection rate for malignancy other than PDAC was 78/86 (91%) with a median of 16 (IQR 12–22) locoregional lymph nodes retrieved.

Conclusion

3dLPD with sPG and ryGES is associated with 1.2% mortality and 25% cPOPF. About two-third of patients with cPOPF were managed with some type of invasive intervention, whereas the intraoperatively placed drains sufficed in one-third of patients.

Clinical trial registry

Clinicaltrials.gov NCT02671357.

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  1. Department of Visceral Surgery, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Halit Topal, Joris Jaekers, Joachim Geers & Baki Topal

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  1. Halit Topal
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Halit Topal, Joris Jaekers, Joachim Geers, and Baki Topal have no conflicts of interest or financial ties to disclose.

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Topal, H., Jaekers, J., Geers, J. et al. Prospective cohort study on short-term outcomes of 3D-laparoscopic pancreaticoduodenectomy with stented pancreaticogastrostomy. Surg Endosc 37, 1203–1212 (2023). https://doi.org/10.1007/s00464-022-09609-9

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  • DOI: https://doi.org/10.1007/s00464-022-09609-9

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