Conventional One-surgeon Team (COST) Versus Two-attending Surgeons Approach (TASA) in Lymph Node Harvest in Patients Undergoing Pancreaticoduodenectomy for Cancer.

BACKGROUND/AIM: Adequate lymph node yield (LNY) is associated with improved relapse-free and overall survival in patients with cancer. In addition, the LNY is a part of complete histopathological diagnosis in cancer. There are several factors which contribute to adequate LNY in pancreatic cancer surgery. This study assessed LNY in conventional one-surgeon teamwork (COST) versus a two-attending surgeons approach (TASA) in patients undergoing pancreaticoduodenectomy for cancer.

PATIENTS AND

METHODS

All consecutive patients undergoing pancreaticoduodenectomy for pancreatic cancer between 2008 and 2025 at Kuopio University Hospital were screened for eligibility and the final study cohort of 236 patients included 142 patients treated via COST and 94 by TASA. Data for both cohorts from a prospectively maintained institutional registry of Kuopio University Hospital included patient demographics, LNY, American Society of Anesthesiologists classification, Charlson Comorbidity Index, body mass index, operative details, and postoperative outcomes.

RESULTS

The median LNY count was significantly higher in the TASA versus COST approach (13 versus 8 lymph nodes, p<0.001), while resection margin status and radicality were equivalent (p=0.78). The TASA approach was associated with significantly reduced blood loss in comparison to COST approach (335 versus 801 ml, p<0.001), despite a longer operative time in (445 versus 334 min, respectively, p<0.001). Severe postoperative complications were less frequent in the TASA group versus the COST group (5.3% versus 14%, p=0.024), and uncomplicated postoperative recovery of patients occurred more often (56% versus 42%, respectively, p=0.033).

CONCLUSION

The TASA approach is associated with improved LNY, reduced blood loss and reduced number of postoperative complications in comparison to COST approach. The TASA approach appears to be a safe and potentially advantageous strategy for pancreaticoduodenectomy.