Pancreatic division at neck reduces pancreatic fistula after laparoscopic distal pancreatectomy compared to at body

Background: We evaluate which site of pancreatic division, neck or body, has better outcomes after laparoscopic distal pancreatectomy (LDP).
Methods: LDP was performed in 102 consecutive patients between December 2009 and May 2020. After excluding 14 patients with pancreatic division at tail, 88 patients (pancreatic division at neck n=46, at body n=42) were included in this study. Short- and long-term outcomes after LDP were compared between pancreatic division at neck and body.
Results: The pancreatic transection site was thicker at body than at neck (17.5 vs. 11.9 mm, P<0.001), although there were no significant differences of pancreatic texture and pancreatic duct size. The Grade B/C postoperative pancreatic fistula (POPF) rate was significantly higher when the pancreas was divided at body than when divided at neck (21.4 vs. 6.5%, P=0.042). We found no significant differences between pancreatic division at neck and body in residual pancreatic volume (34.0 vs. 34.8 ml, P=0.855), incidence of new-onset or worsening diabetes mellitus more than six months after LDP (P=0.218), or body weight change (one-year: P=0.108, tree-year: P=0.131, five-year: P=0.408).
Conclusion: This study suggests that the pancreatic division at neck might reduce the Grade B/C POPF incidence after LDP, compared to division at body. A potential reason is that the pancreas at body is thicker than that at neck.