Abstract
BackgroundThe safety of total laparoscopic pancreaticoduodenectomy still remains controversial. Laparoscopic assisted pancreaticoduodenectomy (LAPD) may be an alternative selection. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon.MethodsA comparison was conducted between LAPD and OPD from January 2013 to December 2018. Perioperative outcomes and short-term oncological results were compared. Univariate and multivariable analyses were performed to determine associations among variables.Results133 patients were enrolled, 36 patients (27.1%) underwent LAPD and 97 (72.9%) underwent OPD. No 30-day and 90-day mortality occurred. LAPD was associated with decreased intraoperative estimated blood loss (300 versus 500 ml; P = 0.002), longer operative time (372 versus 305 min; P < 0.001) compared with OPD. LAPD had a conversion rate of 16.7%, and wasn’t associated with an increased grade B/C pancreatic fistula rate, major surgical complications, intraoperative blood transfusion, reoperation rate or length of hospital stay after surgery. In the subset of 58 pancreatic ductal adenocarcinomas, R0 resection rate, median total harvested lymph node or lymph nodes ≥12 did not differ between the two groups.ConclusionLAPD could be performed with non-inferior short-term perioperative and oncologic outcomes achieved by OPD in selected patients.
Highlights
The safety of total laparoscopic pancreaticoduodenectomy still remains controversial
PD was performed for pancreatic ductal adenocarcinoma (PDAC) in 43.6% of cases (58 patients), peri-ampulla malignancies in 33.8% (45 patients), other non-PDAC pancreatic lesions in 20.3%
In the present study, we represented a large cohort of PDs via open or laparoscopic assisted approaches, which revealed that Laparoscopic assisted pancreaticoduodenectomy (LAPD) had non-inferior perioperative and short-term oncologic outcomes compared with that achieved in open pancreaticoduodenectomy (OPD)
Summary
The safety of total laparoscopic pancreaticoduodenectomy still remains controversial. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon. Minimally invasive pancreaticoduodenectomy (PD) are increasingly reported due to its potential benefits to patients since first described in 1994 by Gagner [1]. What’s more, the controversial safety remains the main concern during wide implementation [2]. A recent multi-institutional data from China reported that 30-day mortality and reoperation rates of minimally invasive PD were higher than that of matched OPD cases [3]. Two western studies reported increased complicationrelated mortality of TLPD compared with OPD [2, 4]. Safety metrics is paramount during the wide implementation of minimally invasive PD. It is necessary to find a minimally invasive approach suitable for learning and implementation
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