Pancreatoduodenectomy combined with intestinal de-rotation as a complete artery-first approach for inexperienced surgeons

Background : Recent technical advances have reduced the incidence of intraoperative complications associated with pancreatoduodenectomy (PD). We aimed to determine whether inexperienced surgeons (ISs) would be as successful as experienced surgeons (ESs) when performing the complete artery-first approach using the intestinal de-rotation method of PD. Methods : Seventy patients who underwent PD using the intestinal de-rotation method in Tokushima University Hospital were enrolled in the present study. Intra- and post-operative parameters were compared between patients operated on by ESs (n = 20) or ISs (n = 50). Results : The surgical procedure lasted longer in the IS group (ES : 402 ± 68 min vs. IS : 483 ± 51 min, p < 0.0001), but the volume of blood loss was similar (p = 0.7304). There was no mortality in either group, and the incidences of postoperative complications with a Clavien-Dindo grade of >III did not differ between the groups. Grade B postoperative pancreatic fistulae developed in 20.0% of patients in the ES group and 22.0% in the IS group (p = 0.9569). Finally, the postoperative hospital stay of the IS group (32 ± 33 days) was equivarent to that of the ES group (33 ± 16 days) (p = 0.9256). Conclusion : ISs were able to perform similarly successful PDs using the intestinal de-rotation method to ESs.