Introduction : Pancreaticoduodenectomy (PD) is associated with various surgical complications including healing failure of the pancreaticojejunostomy (PJ). This study intended to ensure blood supply to the pancreatic stump through extended pancreatic transection (EPT).

Methods : This study intended to assess whether EPT reduces PJ-associated complication and whether EPT induces no harmful effect on the remnant pancreatic function. EPT group included 19 patients undergoing PD, pylorus-preserving PD (PPPD) or hepatopancreaticoduodenectomy. Control group included 45 patients undergone PPPD after propensity score matching. Pancreatic transection was performed at the level of the celiac axis in EPT group, by which the pancreatic body was additionally removed by 3 cm in length comparing with conventional pancreatic transection.

Results : A small invagination fissure, suspected of the embryonic fusion site, was identified at the ventro-caudal edge of the pancreatic body in all patients undergoing EPT. A sizable fissure permitting easy separation of the pancreatic parenchyma was identified in 15 of 19 patients (78.9%). The incidence of significant postoperative pancreatic fistula was significantly lower in EPT group than in control group (p=0.047). There was no significant increase in the postoperative de novo diabetes mellitus in EPT group (p=0.060). Completely secure PJ was observed in 17 of 19 patients (89.5%) in EPT group, but in 33 of 45 patients (73.3%) in control group.

Conclusions : This study demonstrated that EPT technique contributes to prevention of major pancreatic fistula without impairment of the remnant pancreatic function, thus it is worthy of clinical application routinely or at least in patients with any known risk of PJ leak.