Extended pancreatic transection reduced fistula after laparoscopic pancreaticoduodenectomy

In a multicenter randomized trial at four high-volume Chinese centers, 141 patients undergoing laparoscopic pancreaticoduodenectomy were analyzed. Extended transection was associated with fewer clinically relevant pancreatic fistulas and infectious complications than conventional transection.

Trial analyzed 141 patients at four Chinese centers.
CR-POPF occurred in 10.9% versus 26.0%.
Infectious complications were also less frequent with extended transection.
No significant differences were found in other perioperative complications.

This open-label, multicenter randomized controlled trial compared two pancreatic neck transection sites during laparoscopic pancreaticoduodenectomy (LPD) at four high-volume centers in China. Of 152 eligible patients, 141 were included in the modified intention-to-treat analysis: 64 underwent extended pancreatic neck transection (5–10 mm lateral to the left margin of the SMV–portal vein axis) and 77 underwent conventional transection anterior to that axis. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF).

CR-POPF occurred in 10.9% of patients in the extended-transection group and 26.0% in the conventional group (relative risk 0.42, 95% CI 0.19–0.93; P=0.031). Infectious complications were also reported in 10.9% versus 26.0%, respectively (P=0.031). No statistically significant differences were detected in other perioperative complications.

The findings suggest that transection level may affect short-term outcomes after LPD. Applicability may be limited to settings with experience in laparoscopic pancreatic surgery: the trial involved four high-volume centers in China, was open-label, and the analysis included 141 patients. The report does not establish whether results extend to open procedures or lower-volume centers.

In practice

For teams performing laparoscopic pancreaticoduodenectomy, this randomized trial suggests that extended pancreatic neck transection may reduce clinically relevant postoperative fistula and infectious complications compared with conventional transection. The evidence comes from 141 analyzed patients at four high-volume centers in China, with no statistically significant differences in other reported perioperative complications. The results do not establish applicability to open surgery or lower-volume settings, and the study size and setting warrant caution before generalizing the findings.

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Source

Surgical Endoscopy: Effect of pancreatic neck transection site on postoperative complications after laparoscopic pancreaticoduodenectomy: a multicenter randomized controlled trial ↗

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