Effect of pancreatic neck transection site on postoperative complications after laparoscopic pancreaticoduodenectomy: a multicenter randomized controlled trial
In brief
Extended pancreatic neck transection cuts fistulas from 26% to 11%
In a randomized trial of 141 patients undergoing laparoscopic pancreaticoduodenectomy, extending the pancreatic neck cut reduced clinically relevant fistulas from 26% to 11%. Infectious complications also fell, while other perioperative complications did not differ significantly between groups. The results support this approach at experienced centers, but its value in broader practice remains to be established.
- Journal
- Surgical endoscopy (Q1)
- Published
- 5 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jing Zhang, Jiaying You, He Cai, Yongbin Li, Pan Gao, Lei Wang, et al.
- PMID
- 42986422
- DOI
- 10.1007/s00464-026-13419-8
Why clinicians should know about it
- Picked for Surgery (paper of the day, 6 November 2026): Randomized trial of pancreatic transection and fistula risk
Abstract
AIM/BACKGROUND: Theoretical controversy persists regarding the optimal pancreatic neck transection site during laparoscopic pancreaticoduodenectomy (LPD). This study aimed to investigate the impact of pancreatic neck transection level on postoperative complications after LPD. METHODS: This multicenter, open-label, randomized controlled trial was conducted at four high-volume pancreatic surgery centers in China. Patients scheduled for LPD were randomly assigned to undergo pancreatic neck transection at different sites. In the extended pancreatic neck transection (EPNT) group, transection was performed 5-10 mm lateral to the left margin of the superior mesenteric vein-portal vein (SMV-PV) axis. While in the conventional pancreatic neck transection (CPNT) group, transection was carried out anterior to the SMV-PV axis. The primary outcome measure was the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF), and analyses were performed based on the modified intention-to-treat (mITT) analysis. RESULTS: Among 152 eligible patients, 141 were randomized and included in the mITT analysis. Sixty four patients were allocated to the EPNT group and 77 to the CPNT group. The incidence of CR-POPF was 10.9% in the EPNT group versus 26.0% in the CPNT group (RR = 0.42, 95%CI 0.19-0.93, P = 0.031). Additionally, the EPNT group exhibited a significantly lower incidence of infectious complications compared with the CPNT group (10.9% vs. 26.0%, P = 0.031). No statistically significant intergroup differences were detected with respect to other perioperative complications (P > 0.05). CONCLUSION: Compared with CPNT, EPNT significantly reduces the incidences of CR-POPF and infectious complications following LPD without elevating the risk of other complications. TRIAL REGISTRATION NUMBER: NCT05808894.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.