• Jony van Hilst, Thijs de Rooij, Peter B van den Boezem, Koop Bosscha, Olivier R Busch, Peter van Duijvendijk, Sebastiaan Festen, Michael F Gerhards, Ignace H de Hingh, Tom M Karsten, Geert Kazemier, Daniel J Lips, Misha D Luyer, Vincent B Nieuwenhuijs, Gijs A Patijn, Martijn W Stommel, Babs M Zonderhuis, Freek Daams, Marc G Besselink, and Dutch Pancreatic Cancer Group.
• Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. Electronic address: j.vanhilst@amc.nl.
• HPB (Oxford). 2019 Jul 1; 21 (7): 857-864.

BackgroundLaparoscopic pancreatoduodenectomy with open reconstruction (LPD-OR) has been suggested to lower the rate of postoperative pancreatic fistula reported after laparoscopic pancreatoduodenectomy with laparoscopic reconstruction (LPD). Propensity score matched studies are, lacking.MethodsThis is a multicenter prospective cohort study including patients from 7 Dutch centers between 2014-2018. Patients undergoing LPD-OR were matched LPD patients in a 1:1 ratio based on propensity scores. Main outcomes were postoperative pancreatic fistulas (POPF) grade B/C and Clavien-Dindo grade ≥3 complications.ResultsA total of 172 patients were included, involving the first procedure for all centers. All 56 patients after LPD-OR could be matched to a patient undergoing LPD. With LPD-OR, the unplanned conversion rate was 21% vs. 9% with LPD (P < 0.001). Median blood loss (300 vs. 400 mL, P = 0.85), operative time (401 vs. 378 min, P = 0.62) and hospital stay (10 vs. 12 days, P = 0.31) were comparable for LPD-OR vs. LPD, as were Clavien-Dindo grade ≥3 complications (38% vs. 52%, P = 0.13), POPF grade B/C (23% vs. 21%, P = 0.82), and 90-day mortality (4% vs. 4%, P > 0.99).ConclusionIn this propensity matched cohort performed early in the learning curve, no benefit was found for LPD-OR, as compared to LPD.Copyright © 2018. Published by Elsevier Ltd.

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