Fistula Risk Score-Adjusted Comparison of Postoperative Pancreatic Fistula between Laparoscopic versus Open Pancreatoduodenectomy

Abstract

Introduction: To compare the postoperative pancreatic fistula (POPF) between laparoscopic and open pancreatoduodenectomy (PD) according to the fistula risk score (mFRS). Method: We conducted a retrospective analysis of 403 patients who underwent laparoscopic (n=221) or open (n=182) PD between January 2012 and February 2019 by two tertiary hospitals in Korea. POPF was defined and graded by the International Study Group (ISGPS) on Pancreatic Fistula Definition. The FRS was calculated using five parameters of pathology, intraoperative blood loss(ml), duct size(mm) and pancreatic texture. The risk score was stratified into 4 risk categories: 0 point for negligible risk, 1 to 2 points for low risk, 3 to 6 points for intermediate risk, and 7 to 10 points for high risk. Result: The median FRS is significantly higher in laparoscopic group than in open group. (4.31±2.05 vs 3.56±2.1, p=0.002). The incidence of clinically relevant pancreatic fistula (CR-POPF) in laparoscopic and open group was 14.5% and 17.5%, respectively (p=0.158). When adjusting for risk, CR-POPF was also similar between laparoscopic and open group: 9.09% vs 5.08% (p=0.367) at negligible/low risk, 14.6% vs 23.2% (p=0.059) at intermediate risk and 20.8% vs 27.3% (p=0.685) at high risk. Conclusion: The results of this study indicates that CR-POPF was similar for laparoscopic and open PD even after adjusting fistula risk score. However, well-designed large scale study is needed to confirm the safety of laparoscopic PD in comparison with open PD in terms of POPF.