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.