Introduction : Laparoscopic pancreaticoduodenectomy (LPD) is being increasingly performed with comparable outcomes to open pancreaticoduodenectomy (OPD). However, long-term outcomes after LPD in comparison with OPD have been rarely reported. We compared the long-term outcomes of pancreatic anastomosis between LPD and OPD by evaluating anastomosis stricture and parenchymal atrophy.

Methods : We retrospectively reviewed 212 patients who received OPD (n=121) and LPD (n=91) from a single surgeon, from December 2014 to October 2018. We analyzed the long-term outcomes of pancreatic anastomosis by reviewing the postoperative 1-year CT for anastomosis stricture and parenchymal atrophy. Anastomosis stricture was defined as a 30% increase or more in the pancreatic duct diameter, and pancreatic atrophy was defined as a 30% decrease or more in the remnant pancreas parenchyma.

Results : The incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) was 19.8% in LPD and 18.2% in OPD, with no significance. The LPD group was associated with smaller pancreatic duct (2.3 vs 3.3 mm, P=0.041) and soft pancreas (78.0 vs 48.8%, P<0.001). In the OPD group, there were more patients with pancreatic cancer (22 vs 59.5 %, P<0.001). There were no differences in anastomosis stricture (16.5 vs 24.0%, P=0.184). There were significantly more patients with pancreas atrophy in the open group (17.6 vs 33.1%, P=0.011). Multivariate analysis of risk factors for anastomosis stricture and pancreas atrophy showed operative method was not a significant factor.

Conclusions : The results of this study revealed that long term outcomes of LPD were not inferior to OPD in terms of patency of the pancreatic duct and pancreatic atrophy.