Improved outcomes with minimally invasive pancreaticoduodenectomy in patients with dilated pancreatic ducts: a prospective study

Abstract

Background: We hypothesized that patients with dilated pancreatic ducts have improved postoperative outcomes with MIPD compared to OPD. Methods: All patients undergoing pancreaticoduodenectomy between April 2016 and July 2019 were prospectively followed, and perioperative and pathologic variables were compared. Patients with dilated pancreatic ducts (≥3mm) who underwent MIPD (Robotic/ Laparoscopic) were propensity score matched to patients with dilated ducts who underwent OPD and outcomes compared. Likewise, patients with non-dilated pancreatic ducts (< 3mm) were similarly compared. The primary outcome was a composite measure termed the ideal outcome (IO) which required patients to achieve negative margins; experience no complications or readmission and be discharged within seven days. Results: 312 patients underwent PD- 51 (16.4%) MIPD and 212 (83.7%) OPD. Patients who underwent MIPD had significantly longer operative times, less intraoperative blood loss, and a lower rate of 90-day readmission. Patients with dilated pancreatic ducts who underwent MIPD (n=30) had significantly increased intraoperative times, less intraoperative blood loss, less postoperative bleeding/anemia complications, lower overall complication rate, and were discharged from the hospital 3.5 days faster compared to matched OPD patients (n=90) with dilated ducts. MIPD in patients with dilated pancreatic ducts was independently associated with increased IO (OR= 3.04, p=0.021) (Table 3). Conclusion: Patients with pancreatic ducts ≥3mm appear to derive the most benefit from MIPD in terms of less complications and shorter hospital stay.