The clinical impact of early complete pancreatic head devascularisation during pancreatoduodenectomy

Background Early inferior pancreaticoduodenal artery (IPDA) ligation reduces intraoperative blood loss during pancreatoduodenectomy, but the impact on oncologic and long-term outcomes remains unknown. The aim of this study was to review the impact of complete pancreatic head devascularization during pancreatoduodenectomy on blood loss, transfusion rates, and clinicopathologic outcomes. Methods Clinicopathologic and outcome data were retrieved from a prospective database for all pancreatoduodenectomies performed from April 2004 to November 2010 and compared between early (IPDA+; n = 62) and late (IPDA-; n = 65) IPDA ligation groups. Results Early IPDA ligation was associated with reduced blood loss (394 ± 21 vs 679 ± 24 ml, P <.001) and perioperative transfusion (P =.031). A trend toward improved R0 resection was seen in patients with pancreatic adenocarcinoma (IPDA+ vs IPDA-, 100% vs 82%; P =.059), but this did not translate to improved 2-year (IPDA+ vs IPDA-, 76% vs 65%; P =.426) or overall (P =.82) survival. Conclusions Early IPDA ligation reduces blood loss and transfusion requirements. Despite overall survival being unchanged, a trend toward improved R0 resection is encouraging and justifies further studies to ascertain the true oncologic significance of this technique.