Surg Endosc. 2026 Jan 5. doi: 10.1007/s00464-025-12433-6. Online ahead of print.
ABSTRACT
INTRODUCTION: This study aims to evaluate the clinical outcomes of pancreaticoduodenectomy combined with longitudinal pancreatojejunostomy (PD-L) for chronic pancreatitis with a suspicious pancreatic head mass. We evaluated these derived surgical procedures with a focus on pain relief, functional preservation, and oncologic vigilance.
METHODS: This retrospective single-center cohort study analyzed clinical data from 20 consecutive patients diagnosed with chronic pancreatitis who underwent PD-L at the Hepatobiliary Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University between December 2021 and December 2024. We systematically analyzed perioperative parameters, morbidity profiles, and histopathological characteristics. Post-discharge monitoring focused on quantitative pain assessment, pancreatic exocrine and endocrine functional status, and surveillance.
RESULTS: The patients’ cohort comprised 20 male patients (mean age 52.3 ± 10.1 years, range 32-70) who underwent PD-L procedures: open (n = 15), laparoscopic (n = 3), and robotic-assisted (n = 2) approaches. The mean operative time was (387.7 ± 75.1) minutes, with an average intraoperative blood loss of (286 ± 141.0) mL. The mean total length of hospital stay was (18.9 ± 4.6) days. Postoperative complications occurred in 2 patients: one case of abdominal hemorrhage requiring angiographic embolization and one case of delayed gastric emptying managed through endoscopic drainage. Notably, no pancreatic fistula were observed in any case. Pathology revealed chronic pancreatitis in 9 patients, PanIN in 9 (6 PanIN-1, 3 PanIN-2), and pancreatic cancer in 2. Preoperative comparisons between the CP group (n = 9) and the PanIN/malignant group (n = 11) showed no significant differences. Although considerable differences in the smoking index were observed between the two groups, they did not reach statistical significance (p = 0.081). During a median follow-up of 14.5 months, 78.9% (15/19) achieved sustained pain relief without the need for analgesics. Improvements in BMI and enhancements in glycemic regulation were observed in 6 and 5 patients, respectively.
CONCLUSION: PD-L is a safe and effective surgical option for selected CP patients those with a space-occupying lesion in the pancreatic head that may raise suspicion of malignancy, concurrent with calculi-associated dilatation of the main pancreatic duct in the distal pancreatic body and tail segments.
PMID:41489749 | DOI:10.1007/s00464-025-12433-6
