Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):500-507. 10.14701/ahbps.24-082.

Minimally invasive pancreatoduodenectomy with combined venous vascular resection: A comparative analysis with open approach

• Shin DH
• Choi M
• Rho SY
• Hong SS
• Kim SH
• Hwang HK
• Kang CM

• KMID: 2561583
• DOI: http://doi.org/10.14701/ahbps.24-082

Abstract

Backgrounds/Aims
This study aimed to compare the minimally invasive pancreatoduodenectomy with venous vascular resection (MI-PDVR) and open pancreatoduodenectomy with venous vascular resection (O-PDVR) for periampullary cancer.
Methods
Data of 124 patients who underwent PDVR (45 MI-PDVR, 79 O-PDVR) between January 1, 2016, and December 31, 2023, was retrospectively reviewed.
Results
MI-PDVR is significantly better than O-PDVR in terms of perioperative outcomes (median operation time [452.69 minutes vs. 543.91 minutes; p = 0.004], estimated blood loss [410.44 mL vs. 747.59 mL; p < 0.01], intraoperative transfusion rate [2 cases vs. 18 cases; p = 0.01], and hospital stay [18.16 days vs. 23.91 days; p = 0.008]). The complications until the discharge day showed no significant difference between the two groups (Clavien–Dindo < 3, 84.4% vs. 82.3%; Clavien–Dindo ≥ 3, 15.6% vs. 17.7%; p = 0.809). In terms of long-term oncological outcomes, there was no statistical difference in overall survival (OS, 51.55 months [95% CI: 35.95–67.14] vs. median 49.92 months [95% CI: 40.97–58.87]; p = 0.340) and disease-free survival (DFS, median 35.06 months [95% CI: 21.47–48.65] vs. median 38.77 months [95% CI: 29.80–47.75]; p = 0.585), between the two groups. Long-term oncological outcomes for subgroup analysis focusing on pancreatic ductal adenocarcinoma also showed no statistical differences in OS (40.86 months [95% CI: 34.45–47.27] vs. 48.48 months [95% CI: 38.16–58.59]; p = 0.270) and DFS (24.42 months [95% CI: 17.03–31.85] vs. 34.35 months, [95% CI: 25.44–43.27]; p = 0.740).
Conclusions
MI-PDVR can provide better perioperative outcomes than O-PDVR, and has similar oncological impact.

Keyword

Laparoscopic; Robotics; Minimally invasive; Pancreatoduodenectomy; Venous resection

Figure

• 

  Fig. 1 Study design. PD, pancreatoduodenectomy; PV, portal vein; SMV, superior mesenteric vein; O-PDVR, open pancreatoduodenectomy with venous vascular resection; MI-PDVR, minimally invasive pancreatoduodenectomy with venous vascular resection.

• 

  Fig. 2 Combined venous vascular resection during MI-PD. (A) Primary repair of resected venous system. (B) End-to-end anastomosis of resected SMV-SV-PV confluence. MI-PD, minimally invasive pancreatoduodenectomy; SMV, superior mesenteric vein; SV, splenic vein; PV, portal vein.

• 

  Fig. 3 Overall survival (OS) and disease-free survival (DFS) of O-PDVR and MI-PDVR. There were no statistical differences in (A) OS (49.92 months, 95% CI: 40.97–58.87 vs. 51.55 months, 95% CI: 35.95–67.14; p = 0.340) and (B) DFS (median 38.77 months, 95% CI: 29.80–47.75 vs. median 35.06 months, 95% CI: 21.47–48.65; p = 0.585) between the two groups. O-PDVR, open pancreatoduodenectomy with venous vascular resection; MI-PDVR, minimally invasive pancreatoduodenectomy with venous vascular resection; CI, confidence interval; MIS, minimally invasive surgery.

• 

  Fig. 4 Overall survival (OS) rate and disease-free survival (DFS) of O-PDVR and MI-PDVR in PDAC patients. There were no statistical differences in (A) OS (median 48.48 months, 95% CI: 38.16–58.59 vs. median 40.86 months, 95% CI: 34.45–47.27; p = 0.270) and (B) DFS (median 34.35 months, 95% CI: 25.44–43.27 vs. median 24.42 months, 95% CI: 17.03–31.85; p = 0.740) between the two groups. O-PDVR, open pancreatoduodenectomy with venous vascular resection; MI-PDVR, minimally invasive pancreatoduodenectomy with venous vascular resection; PDAC, pancreatic ductal adenocarcinoma; CI, confidence interval.

Reference

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