Combination of Modified Pinch-Burn-Cut (PBC) Technique and Harmonic FOCUS® for Pancreaticoduodenectomy under Preoperative Continuation of Antiplatelets in High Thromboembolic Risk Patients

Abstract

AIM: The aim of the study was to assess the safety and feasibility of pancreaticoduodenectomy (PD) using modified Pinch-Burn-Cut (PBC) technique and Harmonic FOCUS® under continuation of antiplatelet therapy in patients with high thromboembolic risks.

METHODS: Consecutive 78 patients who had undergone PD using combination of modified PBC technique and HF in a tertiary care setting from 2009 to 2016 were retrospectively reviewed. Among which 18 patients with high thromboembolic risks underwent preoperative aspirin continuation and were included in the study. Background and perioperative factors were described with detailed information, and the outcome variables of patients were compared between the pancreatic cancer patients (PC group) and those with the other diseases (non-PC group).

RESULTS: The current cohort included 8 patients in PC group and 10 in non-PC group, respectively. The major indication of APT was history of percutaneous coronary intervention for angina pectoris (15/18, 83.3%). The median of operative time and estimated blood loss were 482 min and 511 mL, respectively. There were no differences between the groups in the operative time, blood loss, or the rates of postoperative complications. None suffered from excessive bleeding requiring platelet transfusion intraoperatively, and there is no case with massive intraoperative bleeding (≥ 1,000 mL). Three minor Grade B post-pancreatectomy hemorrhage (PPH, 16.7%) and 2 Grade B postoperative pancreatic fistula (POPF, 11.1%) occurred postoperatively, but no patient suffered from Grade C PPH/POPF or thromboembolic complications. Operative mortality was zero.

CONCLUSION: PD using modified PBC technique and Harmonic FOCUS® can be performed safely and satisfactorily even in APT-burdened patients with high thromboembolic risks. Maintenance of single APT should be considered in patients with high thromboembolic risk, even when PD is performed.