Advantages of the maneuver of intestinal derotation for pancreaticoduodenectomy

BACKGROUND AND AIMS: Pancreaticoduodenectomy (PD) is the surgical treatment of choice for cephalopancreatic cancer representing the only hope of cure. Since its first description in 1935 by Allan Whipple, several modifications have been proposed. The execution of the Cattell-Braasch maneuver of intestinal derotation (ID) in the course of PD, by restoring the entire bowel to its embryological position, could represent a further and multiexpedient variant. MATERIALS AND METHODS: We retrospectively studied 45 consecutive pancreatic cancer patients treated with Whipple-Child PD in which the Cattell-Braasch procedure of ID was performed as integrative part of the intervention. Additionally, we compared our results with the ones of conventional PD performed through open, laparoscopy, and robotic surgery. Continuous variables of ID-PD were calculated using Student's t-test whereas Mantel-Haenszel method was used for comparison with other non-ID PD techniques. RESULTS: The average operative time was 342 min (range 250-435 min). The median estimated intraoperative blood loss was 460 ml (range 350-570 ml) (p < .0001); no intraoperative blood transfusion was required. The average number of lymph nodes harvested per specimen was 19.4 (range 17-25) (p < .0001). Morbidity and mortality rate was 28.8% and 4.4% (respectively p < .0001 and p = .1596). CONCLUSION: Our data are in keeping with the classical PDs performed without ID. The association of the maneuver of ID with PD seems to bring some important advantages such as wider exposure of the operative field, safer dissection of anatomical structures, less intraoperative blood loss and higher number of sampled lymph nodes.