Laparoscopic versus open pancreatoduodenectomy for ampullary carcinoma is associated with similar survival

Abstract

Background: Few studies have compared the oncological benefit of laparoscopic (LPD) and open pancreatoduodenectomy (OPD) for ampullary carcinoma. The aim of this study was to compare the oncological results of these two techniques. Methods: Between 2011 and 2020, 103 patients who underwent PD for ampullary carcinoma, including 31 LPD and 72 OPD, were retrospectively analyzed. The 31 LPD were matched (1: 2) to 62 OPD for age, sex, BMI, ASA score and preoperative biliary drainage. LPD and OPD were compared. Results: LPD was associated with a shorter operative time (298 vs. 341min, p = 0.02) than OPD and similar blood loss (361 vs. 341mL, p=0.747), but with more transfusions (29 vs. 8%, p = 0.008). There was no significant difference in postoperative mortality (6 vs. 2%), grades B/C POPF (22 vs. 21%), delayed gastric emptying (23 vs. 35%), bleeding (22 vs. 11%), Clavien ≥III morbidity (22 vs.19%), or the length of hospital stay (26 vs. 21 days) between LPD and OPD, respectively, but there were more reinterventions (22 vs. 5%, p = 0.009). Pathological characteristics were similar for tumor size (21 vs. 22mm), well differentiated tumors (41 vs. 38%), the number of harvested (23 vs. 26) or invaded lymph nodes (48 vs. 52%), R0 resection (82 vs. 91%), and other subtypes (T1/2, T3/4, phenotype). With a comparable mean follow-up (41 vs. 37 months, p = 0.59), there was no difference in 1-, 3- and 5- year overall (p=0.725) or recurrence free survival (p=0.155) which were (93, 74, 67% vs. 97, 79, 76%) and (85, 58, 58% vs. 90, 73, 73%), respectively. Conclusion: This study showed similar long-term oncological results with LPD and OPD for ampullary carcinoma.