358 total laparoscopic pancreatoduodenectomy for patients with lesions of the head of the pancreas and periampullary area

Abstract

Purpose: To show our experience in treatment patients with lesions of the head of the pancreas and the periampullary area by using a total laparoscopic approach. Methods: From January 2007 to December 2020 358 patients were taken for laparoscopic pancreaticoduodenectomy at the single center: Whipple procedure(n-271)and pylorus-preserving PD(n-88). There were 211 females and 147 males. The median age 62(range 34-82)years. BMI-26.4(1-98,2-121,3-64). Diagnosis: pancreatic carcinoma(n-160),low bile duct carcinoma(n-32),ampullary carcinoma(n-81),renal cancer metastasis(n-1),duodenal carcinoma(n-19),duodenal melanoma metastasis(n-1),ampullary adenoma(n-13),chronic pancreatitis(n-18),neuroendocrinetumor of the duodenum(n-3),solid pseudopapillary tumor(n-5),ampullary neuroendocrine tumor(n-8),low bile duct adenoma(n-2),intraductal papillary mucinous neoplasm(n-6),lymphoma(n-2),serous cystadenoma of the pancreas (n-1).In a retrospective study we analysed the main outcome measures:blood loss,operative time,length of hospital stay, postoperative complication according to Clavien-Dindo. Results: Median operative time was 423 (range 220-875)min and median blood loss was 294(range 10-2800)ml. Clavien - Dindo: IIIa - n49, IIIb - n36, IV - n12, V - n22. Clinically significant pancreatic fistula occurred in 74 cases (20,6%). Median length of postoperative hospital stay was 16(4-94) days. Conclusion: Totally laparoscopic pancreaticoduodenectomy is safe and effective procedure for patients with cancer of the biliopancreatoduodenal area. The results are comparable with results after open pancreatoduodenectomy. In spite of this, controlled multi-centric trials are needed.