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Updated: Sep 7, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison
Edwin Yang1, Yvette Chong1, Zhongkai Wang1
1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Background:
Minimally invasive pancreatic pancreatoduodenectomy (MIPD) is increasingly adopted worldwide and its potential advantages include reduced hospital stay and decrease pain. However, evidence supporting the role of MIPD for tumours requiring vascular reconstruction remains limited and requires further evaluation. This study aims to investigate the safety and efficacy of MIPD with vascular resection (MIPDV) by performing a 1:1 propensity-score matched (PSM) comparison with open pancreatoduodenectomy with vascular resection (OPDV) based on a single surgeon's experience.
Methods:
This is a retrospective review of 41 patients who underwent PDV between 2011 and 2020 by a single surgeon. After PSM, the comparison was made between 13 MIPDV and 13 OPDV.
Results:
Thirty-six patients underwent venous reconstruction (VR) only and 5 underwent arterial reconstruction of which 4 had concomitant VR. The types of VR included 22 wedge resections with primary repair, 8 segmental resections with primary anastomosis and 11 requiring interposition grafts. Post-operative pancreatic fistula (POPF) occurred in 3 (7.3%) patients. Major complications (>Grade 2) occurred in 16 (39%) patients, of which 7 were due to delayed gastric emptying requiring nasojejunal tube placement. There was 1 (2.4%) 30-day mortality (OPDV). Of the 13 MIPDV, there were 3 (23.1%) open conversions. PSM comparison demonstrated that MIPDV was associated with longer median operative time (720 min vs. 485 min (P = 0.018). There was no statistically significant difference in other key perioperative outcomes such as intra-operative blood loss, overall morbidity, major morbidity rate, POPF and length of stay.
Conclusion:
Our initial experience with the adoption MIPDV has demonstrated it to be safe with comparable outcomes to OPDV despite the longer operation time.
Insights
Minimally invasive pancreaticoduodenectomy with vascular resection (MIPDV) is safe and effective, showing comparable outcomes to open procedures. While operative time is longer, key results like morbidity and hospital stay are similar.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) offers potential benefits like reduced hospital stay and pain.
- Evidence for MIPD in cases requiring vascular reconstruction is limited.
- This study evaluates minimally invasive pancreaticoduodenectomy with vascular resection (MIPDV).
Purpose of the Study:
- To assess the safety and efficacy of MIPDV.
- To compare MIPDV with open pancreatoduodenectomy with vascular resection (OPDV).
- To utilize propensity-score matching for a robust comparison.
Main Methods:
- Retrospective review of 41 patients undergoing pancreaticoduodenectomy with vascular resection (PDV) from 2011-2020.
- 1:1 propensity-score matched comparison between 13 MIPDV and 13 OPDV cases.
- Analysis of perioperative outcomes, including complications and operative time.
Main Results:
- No significant difference in intra-operative blood loss, overall morbidity, major morbidity, POPF, or length of stay between MIPDV and OPDV.
- MIPDV was associated with a longer median operative time (720 min vs. 485 min, P=0.018).
- Post-operative pancreatic fistula (POPF) occurred in 7.3% of patients; 39% experienced major complications.
Conclusions:
- MIPDV is a safe and feasible option for pancreatic tumors requiring vascular resection.
- Outcomes of MIPDV are comparable to OPDV, despite increased operative time.
- Further evaluation of MIPDV is warranted, especially in complex cases.
