BACKGROUND Minimally invasive pancreaticoduodenectomy, either laparoscopic or robotic, is a high-risk procedure with demanding learning curve. The aim of this prospective cohort study was to evaluate short-term clinical and oncologic outcomes of 3D-laparoscopic pancreaticoduodenectomy (3dLPD) with stented pancreaticogastrostomy (sPG) and Roux-en-Y gastroenterostomy (ryGES). METHODS Between March 2016 and July 2021, 347 consecutive patients underwent 3dLPD for confirmed or suspected pancreatic or periampullary tumors. Pancreatic duct diameter measured 3 mm or less in 221 (64%) and pancreatic texture was soft in 191 (55%) patients. Simultaneous resection of the superior mesenteric or portal vein was performed in 52 (15%) patients. RESULTS Postoperative complications were observed in 189 (54%) patients, with severe complications (Clavien-Dindo grade > 2) in 68 (20%) including 4 (1.2%) deaths. Clinically relevant pancreatic fistula (cPOPF) occurred in 88 (25%), hemorrhage in 25 (7%), and bile leakage in 10 (3%) patients. Clinical pancreatic fistula was strongly associated with soft pancreatic texture and small pancreatic duct diameter (p < 0.001) and managed by endoscopic trans-gastric drainage in 34 (38.6%) patients, reoperation in 12 (13.6%), and ICU admission in 11 (12.5%). The remaining 31 (35%) patients with cPOPF were managed without invasive intervention. Median length of hospital stay after surgery was 13 (range 5-112; IQR 8-18) days. In pancreatic adenocarcinoma (PDAC) the R0-resection rate was 66/186 (36%), R1-indirect 95/186 (51%), and R1-direct 25 (13%). Median number of locoregional lymph nodes retrieved in PDAC was 21 (IQR 15-28). R0-resection rate for malignancy other than PDAC was 78/86 (91%) with a median of 16 (IQR 12-22) locoregional lymph nodes retrieved. CONCLUSION 3dLPD with sPG and ryGES is associated with 1.2% mortality and 25% cPOPF. About two-third of patients with cPOPF were managed with some type of invasive intervention, whereas the intraoperatively placed drains sufficed in one-third of patients. CLINICAL TRIAL REGISTRY Clinicaltrials.gov NCT02671357.

中文翻译：

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3D 腹腔镜胰十二指肠切除术与支架式胰胃吻合术短期结果的前瞻性队列研究。

背景技术微创胰十二指肠切除术，无论是腹腔镜手术还是机器人手术，都是一种高风险的手术，学习曲线要​​求很高。这项前瞻性队列研究的目的是评估 3D 腹腔镜胰十二指肠切除术 (3dLPD) 与支架式胰胃吻合术 (sPG) 和 Roux-en-Y 胃肠吻合术 (ryGES) 的短期临床和肿瘤学结果。方法 2016 年 3 月至 2021 年 7 月，连续 347 名患者因确诊或疑似胰腺或壶腹周围肿瘤接受了 3dLPD。221 名 (64%) 患者的胰管直径为 3 毫米或更小，191 名 (55%) 患者的胰腺质地柔软。52 名 (15%) 患者同时切除了肠系膜上静脉或门静脉。结果 189 例 (54%) 患者出现术后并发症，68 例 (20%) 出现严重并发症（Clavien-Dindo 分级 > 2），其中 4 例 (1.2%) 死亡。88 例 (25%) 发生临床相关胰瘘 (cPOPF)，25 例 (7%) 发生出血，10 例 (3%) 发生胆漏。临床胰瘘与柔软的胰腺质地和小胰管直径密切相关 (p < 0.001)，34 例 (38.6%) 患者通过内镜经胃引流治疗，12 例 (13.6%) 再次手术，11 例患者入住 ICU ( 12.5%)。其余 31 名 (35%) 的 cPOPF 患者在没有侵入性干预的情况下得到管理。手术后住院时间中位数为 13（范围 5-112；IQR 8-18）天。在胰腺癌 (PDAC) 中，R0 切除率为 66/186 (36%)，R1 间接切除率为 95/186 (51%)，R1 直接切除率为 25 (13%)。在 PDAC 中检索到的局部区域淋巴结中位数为 21 (IQR 15-28)。除 PDAC 外，恶性肿瘤的 R0 切除率为 78/86 (91%)，局部区域淋巴结切除的中位数为 16 (IQR 12-22)。结论 使用 sPG 和 ryGES 的 3dLPD 与 1.2% 的死亡率和 25% 的 cPOPF 相关。大约三分之二的 cPOPF 患者接受了某种类型的侵入性干预，而术中放置的引流管足以满足三分之一患者的需要。临床试验注册处 Clinicaltrials.gov NCT02671357。而术中放置的引流管足以满足三分之一患者的需要。临床试验注册处 Clinicaltrials.gov NCT02671357。而术中放置的引流管足以满足三分之一患者的需要。临床试验注册处 Clinicaltrials.gov NCT02671357。