Comparative Severe Complications After Laparoscopic Pancreatoduodenectomy in PDAC vs Non‐PDAC Periampullary Cancer: A Retrospective Cohort Study

INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) offers the potentially clinical benefit for patients presenting with periampullary tumors. The aim of this study is to evaluate postoperative clinical outcomes among patients undergoing LPD for periampullary cancer. STUDY DESIGN: We retrospectively reviewed and analyzed 574 consecutive patients received LPD for periampullary cancer at our institution between April 2011 and August 2024. Data collected included preoperative, perioperative, and postoperative information. RESULTS: Among 574 patients undergoing LPD for periampullary cancer, 311 (54.2%) pathologically diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 263 (45.8%) had non-PDAC periampullary cancer. Compared with PDAC, non-PDAC patients experienced significantly higher rates of major morbidity (16.7% vs 10.9%, p = 0.043), including postoperative pancreatic fistula (p = 0.001), abdominal infection (p = 0.032), and reoperation (p = 0.021). Multivariate analysis identified age ≥ 65 years (OR 1.803, 95%CI: 1.092 ~ 2.978), prolonged operative time (OR 1.004, 95%CI: 1.001 ~ 1.006), and non-PDAC pathology (OR 1.664, 95%CI: 1.014 ~ 2.731) as independent risk factors for severe complications, while pylorus preservation was protective (OR 0.460, 95%CI: 0.264 ~ 0.803). CONCLUSION: Postoperative morbidity after LPD varies by periampullary cancer subtype, with non-PDAC patients at greater risk of severe complications. Older age, prolonged operative time, and non-PDAC pathology were independent predictors of severe complications, whereas pylorus preservation conferred a protective effect.