Extended Pancreatic Transection Versus Conventional Pancreatic Transection During Laparoscopic Pancreaticoduodenectomy

Study Overview
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Brief Summary
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The level of pancreatic neck transection during laparoscopic pancreaticoduodenectomy (LPD) is not conclusive. Theoretically, the level of pancreatic transection can significantly affect the occurrence of postoperative pancreatic fistula (POPF) by influencing both the blood supply to the anastomosis and the location of the main pancreatic duct in the pancreatic transverse section. The investigators conduct a retropective propensity score-matched comparison to compare the impact of extended pancreatic transection and conventional pancreatic transection on POPF and the performance of the pancreaticojejunostomy during LPD.

Official Title
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Extended Pancreatic Transection Versus Conventional Pancreatic Transection During Laparoscopic Pancreaticoduodenectomy: a Retrospective Propensity Score-matched Comparison

Conditions
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Laparoscopic Pancreaticoduodenectomy

Intervention / Treatment
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* Procedure: extended pancreatic transection during laparoscopic pancreaticoduodenectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: consecutive patients underwent elective laparoscopic pancreaticoduodenectomy within October 2019 to April 2023 the perioperative and follow-up study data information can be collected completely The level of pancreatic neck dissection can be determined by postoperative abdominal CT patients without the history of neoadjuvant chemotherapy or radiotherapy Exclusion Criteria: conversion to laparotomy due to various reasons during operation; combined with resection and reconstruction of the portal vein or the superior mesenteric vein combined with other organ resection the perioperative and follow-up study data information can not be collected completely, or the level of pancreatic neck dissection can not be determined by postoperative abdominal CT patients with the history of neoadjuvant chemotherapy or radiotherapy the main pancreatic duct did not be found during the operation, the duct-to-mucosa pancreaticojejunostomy could not be performed

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| extended pancreatic transection cohort<br>cases in which the pancreatic transection was performed at the pancreatic neck beyond the left side of the mesenterico-portal axis during laparoscopic pancreaticoduodenectomy, as judged by postoperative abdominal CT scan. | Procedure: extended pancreatic transection during laparoscopic pancreaticoduodenectomy<br>* the pancreatic transection was performed at the pancreatic neck beyond the left side of the mesenterico-portal axis during laparoscopic pancreaticoduodenectomy<br>|
| conventional pancreatic transection cohort<br>cases in which the pancreatic transection was performed at the pancreatic neck above the mesenterico-portal axis during laparoscopic pancreaticoduodenectomy, as judged by postoperative abdominal CT scan. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the incidence of clinically relevant pancreatic fistula | the incidence of the clinically relevant pancreatic fistula according the International Study Group of Pancreatic Surgery's definition and grading | 3 months postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| surgical performance of pancreaticojejunostomy | the duration of pancreaticojejunostomy | intraoperatively | 
| postoperative morbidity | postoperative morbidity (Clavien-Dindo score ≥3) within 3 months postoperatively | 3 months postoperatively | 
| postoperative mortality | mortality within 3 months postoperatively | 3 months postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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laparoscopic pancreaticoduodenectomy, pancreatic transection level