Abstract
To evaluate a risk-adjusted comparison of clinically relevant postoperative pancreatic fistula POPF (CR-POPF) following laparoscopic pancreatoduodenectomy (LPD) vs open pancreatoduodenectomy (OPD) using the fistula risk score (FRS). We retrospectively analyzed 579 patients who underwent LPD (n=274) or OPD (n=305) between 2012 and 2019 at two tertiary hospitals. Using the FRS, the risk was stratified into four categories; negligible, low, intermediate and high risk. The median FRS was significantly higher in the LPD than in the OPD group (5.4±1.2 vs 3.9±1.8, P<.001). The overall incidence of CR-POPF in the LPD vs OPD groups were 16.4% vs 17.7% (P=.187). When POPF risks were stratified by FRS, CR-POPF following LPD vs OPD in patients with low risk (0% vs 6.3%, P=.294), intermediate risk (16.1% vs 22.9%, P=.053) and high risk (33.3% vs 27.3%, P=.577) were not significantly different. Despite a higher risk score in the LPD group, the CR-POPF was similar following both procedures in the unadjusted and FRS-risk-adjusted comparisons. The CR-POPF was more significantly affected by patient risk factors such as the soft pancreas and small pancreatic duct.
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