Abstract
Introduction: Laparoscopic pancreatoduodenectomy (LPD) is still a challenging operation and its safety and feasibility are controversial. We demonstrate our institutional procedure to obtain satisfactory results comparing to open pancreatoduodenectomy (OPD) for similar disease (benign and low-grade malignant tumor). Methods: From 2016, 14 consecutive patients underwent LPD for 6 PNET, 3 IPMN and 5 Duodenal tumors. Our techniques are following; 2 surgeons who have experienced over 200 laparoscopic digestive surgeries and 200 OPD perform Operator or Scopist alternatively; Scopist provides a good field of vision as first assistant; usage of 3-dimentional visualization; via mini-laparotomy (7cm) a pancreatico-jejunostomy and duodeno-jejunostomy are performed; a choledoco-jejunostomy is performed laparoscopically. All patients revealed soft pancreatic texture and the Fistula Risk Score (FRS) demonstrated 5 high and 9 moderate-risk patients in LPD and 4 high and 6 moderate in OPD. Results: Mean operation time was not different between the groups (LPD, 284 min; OPD, 289 min). Mean blood loss was significantly greater in OPD (LPD, 181 ml; OPD, 461 ml; p = 0.024). Median postoperative hospital stay was not different between the groups, but shorter in LPD (LPD, 15d; OPD, 21d). There were no differences in postoperative complications (LPD, 43%; OPD, 40%) and clinical pancreatic fistula (LPD, 36%; OPD, 30%). There were no reoperation and mortality in both groups. Conclusion: LPD offers the equivalent surgical outcome with OPD, while achieve less intraoperative blood loss and shorter hospital stay. The candidates of this surgery correspond to high FRS, thus we have to continue the meticulous surgery using partially open method to minimize morbidities.
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