Laparoscopic repeated pancreatectomy is feasible and safe: Monocentric comparative study to open approach of 72...

Patients undergoing pancreatectomy are at risk of recurrence in the remnant pancreas, and a repeated pancreatectomy may be indicated. Although the open repeated pancreatectomy remains standard, laparoscopic repeated pancreatectomy has rarely been reported. This study aimed to compare outcomes between laparoscopic repeated pancreatectomy and open repeated pancreatectomy in a large monocentric cohort.

All consecutive patients who underwent repeated pancreatectomy between March 2012 and November 2024 were retrospectively studied. The primary endpoint was major morbidity (Clavien-Dindo grade ≥III) within 90 postoperative days. Secondary endpoints included clinically relevant postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, perioperative mortality, and long-term survival. A subgroup analysis was conducted in patients undergoing completion pancreatoduodenectomy or completion distal pancreatectomy.

Seventy-two repeated pancreatectomies were performed in 69 patients, including 37 laparoscopic repeated pancreatectomies and 35 open repeated pancreatectomies. The initial pancreatic resection was laparoscopic in 54% of the laparoscopic repeated pancreatectomy group (20 of 37) and open in 94% of the open repeated pancreatectomy group (33 of 35) (P < .001). Distal pancreatectomy was the most frequent initial pancreatic resection (46%), followed by pancreatoduodenectomy (38%). Repeated most involved pancreatectomy was the pancreatoduodenectomy (50%), followed by distal pancreatectomy (40%), with no significant difference between the 2 groups. Laparoscopic repeated pancreatectomy compared with open repeated pancreatectomy showed a similar rate of major morbidity (14 of 37 vs 14 of 35), with no mortality in either group. Rates of postoperative pancreatic fistula (6% vs 3%, P = .614), delayed gastric emptying (8% vs 20%, P = .280), and postpancreatectomy hemorrhage (3% vs 9%, P = .337) did not differ significantly. In the pancreatoduodenectomy subgroup (n = 36), laparoscopic repeated pancreatectomy was associated with fewer venous resections (1 of 17 vs 7 of 19, P = .031) and reduced blood loss (179 mL vs 342 mL, P = .033). In the subgroup of patients with pancreatic cancer, overall and disease-free survival was similar between laparoscopic repeated pancreatectomy and open repeated pancreatectomy.

In this high-volume center, laparoscopic repeated pancreatectomy was feasible and safe, with comparable outcomes to the open approach.