Abstract
PurposeThe aim of this study was to discuss the feasibility of laparoscopic ‘uncinate first’ pancreatoduodenectomy.MethodsThe analysis included prospectively collected data from 12 consecutive patients undergoing elective pure laparoscopic ‘uncinate process first’ pancreatoduodenectomy (Group 1). They were compared with patients previously operated on with a classical laparoscopic approach (Group 2). The primary outcome was the quality of the resected specimen (lymph node (LN) yield, R0 rate, involved resection margins). Secondary outcomes were perioperative parameters.ResultsThe LN yield in Group 1 was 19.3 and in Group 2 it was 13.9 (p = 0.03). R0 resection rates did not vary (66.7 vs. 63.2%, p = 0.84). Although the involvement of the superior mesenteric artery margin and uncinate process margin seemed lower in Group 1, the difference was not significant. Total operative time (467 vs. 425 min, p = 0.13) and resection time (221 vs. 232 min, p = 0.34) were similar in both groups. The estimated blood loss in Group 1 was 408 ml, whereas in Group 2 it was 392 ml (p = 0.33). Complication rates were 66.7% in Group 1 and 63.2% in Group 2 (p = 0.84). Median length of stay was 9 days in both groups (p = 0.36). Postoperative complication rates did not differ between groups.ConclusionsLaparoscopic uncinate first approach is a feasible method for pancreatic head neoplasms. Achieved quality of the specimen is comparable with the traditional laparoscopic approach, whereas intra- and postoperative course is not inferior. However, further studies on larger cohorts are required to fully establish whether the novel approach has potential advantages over classical access in pancreatic head cancer.
Highlights
The first laparoscopic pancreatoduodenectomy (LPD) was reported over 20 years ago by Gagner and Pomp
Laparoscopic uncinate first approach is a feasible method for pancreatic head neoplasms
Achieved quality of the specimen is comparable with the traditional laparoscopic approach, whereas intra- and postoperative course is not inferior
Summary
The first laparoscopic pancreatoduodenectomy (LPD) was reported over 20 years ago by Gagner and Pomp. Several comparative studies, published in recent years, have confirmed the feasibility of laparoscopy in cases of pancreatic head malignancy [1, 2]. Minimally invasive oncologic surgery has become an accepted approach for many abdominal operations, it is still used to a limited extent in pancreatic surgery [3]. It is generally accepted that the laparoscopic approach should follow the same principles as open surgery. LPD is, without a doubt, one of the most complex abdominal procedures, involving recognition of difficult anatomy, meticulous vascular dissection and multiple gastrointestinal tract reconstructions. For this reason, the risk of the course of surgery not following the principles of classical pancreatic head surgery is high
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