Minimally Invasive Pancreaticoduodenectomy: Similar Morbidity and No Mortality in the Learning Period.

Objectives: Pancreaticoduodenectomy (PD) is one of the most challenging operations in gastrointestinal system due to the difficulty of dissection areas and the need for complex reconstruction. The aim of this study is to compare the morbidity, post-operative pancreatic fistula (POPF), and mortality rates of the cases we have from the learning period for minimally invasive PD and our previous open PD cases with similar fistula risk scores (FRSs).

Methods: Patients with similar age, ASA score, pre-operative drainage, and FRS were included in the study. A total of 71 patients, 48 of whom were operated with open surgery and 23 with minimally invasive methods, were included in the study.

Results: When the statistical analysis performed, no statistically significant difference was found between open surgery and minimally invasive surgery groups in terms of age, gender, ASA score, pre-operative drainage, pancreatic texture, and treatment of pancreatic leakage (p=0.27, p=0.09, p=0.4, p=0.39, p=0.76, and p=0.36, respectively). There was a statistically significant difference between two groups in terms of clinically relevant pancreatic anastomotic leakage (Grade-B and Grade-C fistula) (p=0.11). The rate of Grade-BL and B leakage was higher in the minimally invasive surgery group, while Grade-C fistula was not observed in any patient (p=0.002). However, there was no statistically significant difference between the two groups in terms of the management of pancreatic leakage and related morbidity (p=0.36). There was no significant difference between the two groups in terms of tumor size, number of lymph nodes removed, FRS, amount of intraoperative bleeding, and diameter of Wirsung and common bile duct (p=0.15, p=0.20, p=0.145, p=0.80, and p=0.073, respectively). Considering the operation time, it was found that the operation time was longer in patients who received minimally invasive surgical treatment and this was statistically significant (p<0.0001).

Conclusion: As a result, we believe that minimally invasive PD operation can be performed with similar morbidity and acceptable CR-POPF rates when compared with the open PD with similar FRS at the learning stage.