Experience of 215 totally laparoscopic pancreatoduodenectomies

Abstract

Background: Two hundred and fifteen laparoscopic pancreatoduodenectomies were performed by single surgical team. Objective is to assess the short-term and long-term results of this operation performed in patients with pancreatic head and periampullary area diseases. Methods: Treatment results of 215 patients underwent laparoscopic pancreatoduodenectomies were analyzed to evaluate short-term outcomes including blood loss, operative time, postoperative pancreatic fistula rate, postoperative complication according to Clavien-Dindo. Oncological outcomes of cancer patients were analyzed to evaluate long-term results. Among 215 patients 122 were females and 93 were males. Mean age was 60 years (range 32–82). 188 patients were operated on because of malignancies and 27 because of benign diseases. Results: Mean operative time was 427 (range 240–875) min and mean blood loss was 400 (range 10–2100) ml. Clinically relevant postoperative pancreatic fistulas (POPF) were diagnosed in total of 14,8% patients, among them 12,1% were classified as grade B POPF and 2,7 as grade C. Postoperative course of 35,5% of patients was complicated by Clavien-Dindo IIIa-V complication. Among them IIIa – 21,9%, IIIb – 7%, IV – 0,45%, V – 5,6%. R0 was achieved in 94% of cases, mean number of harvested lymph nodes was 17. 70 patients with pancreatic ductal adenocarcinoma were followed up. 3-years overall survival rate (OSR) was 31,3%, 5-years OSR was 25,2%. Median survival time was 22,5 months. Among patients with papillary cancer 31 patients were followed up. Both 3-years and 5-years OSR were 67%. Conclusion: Totally laparoscopic pancreaticoduodenectomy is safe and effective procedure for patients with pancreatic head and periampullary area diseases.