Laparoscopic pancreatoduodenectomy and venous resection are safe in selected patients: a monocentric comparative...

Ensuring oncologic resections margins may involve venous resection (VR) during pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Data regarding laparoscopic VR surgical outcomes in comparison with the open approach are lacking. Hence, we sought to compare the outcomes of laparoscopic PD (LPD) and open PD (OPD) with VR.

We retrospectively analyzed data from patients with resectable or borderline PDAC undergoing LPD or OPD with lateral or segmental portal/superior mesenteric vein resection in a high-volume center between 2012 and 2023.

Ninety-eight patients were included (30 LPD and 68 OPD). Patients in both groups had similar median age (62 vs 67, P = 0.166). Patients who underwent LPD had less neoadjuvant chemoradiotherapy (63% vs 91%, P = 0.003), but more lateral VR (83% vs 63%, P = 0.058), more reconstructions with a peritoneal patch (43% versus 19%, P = 0.024), longer median clamping time (28 vs 15 min, P < 0.001) and operative time (383 vs 255 min, P < 0.001). Patients in the LPD group showed similar rate of Clavien-Dindo morbidity > II (27% vs 16%, P = 0.271), 90-day mortality (3% vs 2%, P = 0.521), median length of stay (14 vs 14 days, P = 0.890), and R0 resection rate (73% vs 89%, P = 0.066) when compared to patients in the OPD group. At 6-month follow-up, venous patency rates between both groups was similar (76% vs 73%, P = 0.691).

LPD and OPD with VR have similar short-term and oncologic outcomes for patients with resectable or borderline PDAC.