Preferential Mobilization of Colonic Hepatic Flexure Facilitates Pancreaticoduodenectomy Procedures

Background: Several studies recommend that colonic hepatic flexure (CHF) should be mobilized preliminarily in minimally invasive pancreaticoduodenectomy (PD). However, there are little data to support that preferential mobilization of the CHF can positively affect the perioperative events of PD. We aimed to assess the effect of preferential mobilization of the CHF in PD. Methods: A retrospective cohort study of patients who underwent PD was performed between 2016 and 2019. Clinical characteristics, operative data, and postoperative surgical complications were recorded. Results: The study included 668 patients; 486 patients underwent open pancreaticoduodenectomy (OPD) and 182 patients underwent laparoscopic pancreaticoduodenectomy (LPD). Patients were divided into CHF-M (OPD, n=129; LPD, n=95) and conventional (OPD, n=357; LPD, n=87) groups according to preferential CHF mobilization. There were no differences between the groups regarding most demographics. Within patients who underwent OPD, decreased estimated blood loss (EBL) (251.2 +/- 146.4 vs. 307.3 +/- 173.5 mL, P<0.05) was observed in CHF-M group. Within patients who underwent LPD, operative time (328.7 +/- 66.3 vs. 406.5 +/- 85.5 min, P<0.001), EBL (166.8 +/- 96.4 vs. 271.8 +/- 130.7 mL, P<0.001), the incidence of clinically relevant pancreaticfistula (7.4% vs. 23.0%, P<0.05), and length of stay (12.3 +/- 5.1 vs. 16.0 +/- 7.4 d, P<0.05) were decreased in CHF-M group. Moreover, patients with high body mass index who underwent LPD showed more significant differences in operative time (336.0 +/- 67.7 vs. 431.9 +/- 79.1, P<0.001) and EBL (179.6 +/- 97.8 vs. 278.2 +/- 135.6, P<0.001) between groups. Conclusion: We first demonstrated that preferential mobilization of the CHF can facilitate PD. The patients who underwent minimally invasive surgery and the patients with high body mass index may benefit more from this technique.