Laparoscopic pancreatoduodenectomy for patients with borderline resectable pancreatic ductal adenocarcinoma: feasibility and outcomes

Abstract

Introduction: Outcomes of laparoscopic pancreatoduodenectomy(LPD) for borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) have not been reported. Our aim is to evaluate the feasibility, safety, outcomes of LPD for BR PDAC. Methods: Retrospective review of patients undergoing LPD for BR and resectable PDAC at our institution (2010-2017). NCCN definition used for BR. Results: 55 patients with BR and 112 with resectable PDAC were identified. Tumor size (3.0 vs. 2.5cm,p< 0.001), and receipt of neoadjuvant therapy (62% vs. 14%, p< 0.001) was increased in the BR group. Operative time (444 vs. 350min, p< 0.001), estimated blood loss (500 vs. 300mL, p=0.002), mesoportal vein resection (66% vs 13%, p< 0.001) and conversion laparotomy (18% vs 4%, p=0.002) was greater in the BR group. Lymph nodes retrieved and R0 resection rates were similar as were major complications, length of hospital stay, and 90-day mortality. Of patients with BR disease, 34 patients received neoadjuvant chemotherapy, 21 did not. Of patients with neoadjuvant treatment, tumor size and CA 19-9 were greater compared to those with upfront surgery (3.5 vs 2.6cm, p=0.003, 288 vs 98U/mL, p=0.012, respectively). Mesoportal vein resection, major complications, median length of hospital stay, and 90-day mortality did not differ between groups. N0 (77% vs. 5%, p< 0.001) and R0 rates (97% vs. 76%, p=0.026) were significantly higher in the neoadjuvant group. Conclusions: LPD for patients with BR PDAC is feasible and safe demonstrating outcomes similar to those reported for open approaches. Neoadjuvant therapy is associated with improved nodal and margin negative rates.