Incidence of bifid pancreatic duct in pancreaticoduodenectomy and its impact on clinically relevant postoperative pancreatic fistula

Liu Ouyang; Hao Hu; Gang Nie; Li-Xue Yang; Zhi-Ping Huang; Chen-Ming Ni; Zhuo Shao; Kai-Lian Zheng; Wei Jing; Bin Song; Gang Li; Xian-Gui Hu; Gang Jin

doi:10.3389/fonc.2022.934978

Incidence of bifid pancreatic duct in pancreaticoduodenectomy and its impact on clinically relevant postoperative pancreatic fistula

Front Oncol. 2022 Aug 17:12:934978. doi: 10.3389/fonc.2022.934978. eCollection 2022.

Authors

Liu Ouyang¹, Hao Hu¹, Gang Nie¹, Li-Xue Yang², Zhi-Ping Huang³, Chen-Ming Ni¹, Zhuo Shao¹, Kai-Lian Zheng¹, Wei Jing¹, Bin Song¹, Gang Li¹, Xian-Gui Hu¹, Gang Jin¹

Affiliations

¹ Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
² Department of Biliary Tract Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
³ Department of Hepatobiliary Surgery, General Hospital of Southern Theatre Command, Guangzhou, China.

Abstract

Objectives: This study aimed to examine the incidence of bifid pancreatic duct (BPD) in pancreaticoduodenectomy (PD) and clarify its impact on clinically relevant postoperative pancreatic fistula (CR-POPF).

Background: Until now, all the literature about BPD during PD are published as case reports, and the incidence of BPD in PD and its impact on CR-POPF remain unknown.

Results: A total of 438 consecutive PDs were divided into two groups: the former year group and the latter year group. The former year group included 215 consecutive PDs, while the latter year group included 223. In the latter year group, we found 16 BPDs during PD (O-BPD); the incidence of O-BPD is 7.17%. Of them, there were eight patients who had BPD in the preoperative imaging (I-BPD). All the I-BPDs are O-BPDs; which means that 50% of O-BPDs were a single pancreatic duct in the preoperative imaging (I-SPD). There were 17 I-BPDs in the 438 consecutive PDs; the incidence of I-BPD is 3.88%. In the former year group, the rate of severe complications of I-BPD and I-SPD is 77.78% and 27.18%, respectively (p = 0.003); the rate of CR-POPF of I-BPD is higher than I-SPD, 55.56% vs. 27.18%, but there were no statistically significant differences. In the latter year group, the rate of severe complications of O-BPD and O-SPD is 50% and 18.36%, and the rate of CR-POPF of O-BPD and O-SPD is 37.5% and 22.22%, respectively; both of them have statistically significant differences, and the p-value is 0.003 and 0.006, respectively. In the subgroup analysis, both the rate of severe complications and the rate of CR-POPF of I-BPD were higher than O-BPD, 77.78% vs. 50%, and 55.56% vs. 37.5%, but there were no statistically significant differences in both of them; the p-value is 0.174 and 0.434, respectively. Univariate and multivariate analyses showed that BPD was an independent risk factor of CR-POPF.

Conclusions: The incidence of O-BPD in PD is 7.17%, 50% of O-BPDs were I-SPD, and the incidence of I-BPD is 3.88%. BPD is an independent risk factor of CR-POPF. The suture closure method may be a simple, safe, and effective method in dealing with BPD in PD.

Keywords: CR-POPF; bifid pancreatic duct; morbidity; nomogram; pancreaticoduodenectomy.