Abstract
Several studies have compared laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with periampullary carcinoma; however, only a few studies have made such a comparison on patients with ampulla of Vater cancer (AVC). We compared the perioperative and oncologic outcomes between LPD and OPD in patients with AVC using propensity-score-matched analysis. A total of 359 patients underwent PD due to AVC during the study period (76 LPD, 283 OPD). After propensity score matching, the LPD group showed significantly longer operation time than did the OPD group (400.2 vs. 344.6 min, p < 0.001). Nevertheless, the LPD group had fewer painkiller administrations (8.3 vs. 11.1, p < 0.049), fewer Grade II or more severe postoperative complications (15.9% vs. 34.8%, p = 0.012), and shorter postoperative hospital stays (13.7 vs. 17.3 days, p = 0.048), compared with the OPD group. There was no significant difference in recurrence-free outcomes and overall survival between the two groups (p = 0.754 and 0.768, respectively). Compared with OPD, LPD for AVC had comparative oncologic outcomes with less pain, less postoperative morbidity, and shorter hospital stays. LPD may serve as a promising alternative to OPD in patients with AVC.
Highlights
Ampulla of Vater cancer (AVC) is defined as a malignancy that arises within the ampullary complex, distal to the confluence of the distal common bile duct and the pancreatic duct
We retrospectively reviewed the oncologic and perioperative outcomes of AVC following laparoscopic pancreaticoduodenectomy (LPD) and open PD (OPD) performed at a single large volume center and performed propensity score matching in order to compare the two surgical methods in terms of oncologic adequacy and perioperative outcomes
CR-postoperative pancreatic fistula (POPF) (8.7% vs. 21.7%, p = 0.029) and Grade II or more severe postoperative complications (15.9% vs. 34.8%, p = 0.012) were less common in the LPD group
Summary
Ampulla of Vater cancer (AVC) is defined as a malignancy that arises within the ampullary complex, distal to the confluence of the distal common bile duct and the pancreatic duct. Following its first description by Gagner et al in 1994 [3], LPD has been evaluated for its adequacy and feasibility in numerous studies [4,5,6,7,8,9,10,11,12,13,14]. Only a few reports have solely evaluated LPD for AVC [15,16], which included a small number of patients and lacked adequate matched groups that received open PD (OPD) for comparison [15]. We retrospectively reviewed the oncologic and perioperative outcomes of AVC following LPD and OPD performed at a single large volume center and performed propensity score matching in order to compare the two surgical methods in terms of oncologic adequacy and perioperative outcomes
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