Laparoscopic pancreaticoduodenectomy for resection of periampullary tumors should be routine?

Abstract

Background: PD is acomplex abdominal procedure. The hospital mortality rate has decreased to <5% however the rate of postoperative morbidities remains high 40%. Laparoscopic pancreaticoduodenectomy (LPD) has not yet been well established approach for periampullary tumour. We present our experience with LPD. Methods: Patients undergoing LPD between 2014 and 2018 Included in the study. Patients who underwent a hybrid LPD (HLPD) mobilization approach and resection followed by open reconstruction and totally LPD (TLPD) approach were included in this study. Operative characteristics, perioperative outcomes, and pathological were collected. Results: Thirty Eight patients underwent LPD including 10 HLPD (26.3%) and 28 TLPD (73.7%) patients. HLPD patients were mostly converted to open for planned reconstruction or anesthetic problem. Median operating time was 370 min (420 min for TLPD). Median length of hospital stay was 6 days. Histology showed 35 invasive malignancies, two neuroendocrine tumours, and one benign lesions. Median nodal harvest was 14. Margin negative resection was achieved in 97.4 % of patients. Twenty-two percent of patients developed a Grade 3∕4 complication, including 12% clinically significant pancreatic fistula. There was one perioperative mortality (2.6%) due to pancreatic fistula. These results are comparable with a well marched cases underwent open PD in the same period of study. Conclusions: LPD is a technically challenging operation with a steep learning curve. The early surgical outcomes are satisfactory. LPD offers benefits to patients as it is minimal invasive procedure so it should be a routine procedure in a well equipped center with good selection of the patients.