Abstract
PurposeNo accepted benchmarks for open pancreaticoduodenectomy (PD) exist. The study assessed the time to functional recovery after open PD and how this could be affected by the magnitude of midline incision (MI).Materials and methodsProspective snapshot study during 1 year. Time to functional recovery (TtFR) was assessed for the entire cohort. Further analyses were conducted after excluding patients developing a Clavien-Dindo ≥ 2 morbidity and after stratifying for the relative length of MI.ResultsThe overall median TtFR was 7 days (n = 249), 6 days for uncomplicated patients (n = 124). A short MI (SMI, < 60% of xipho-pubic distance, n = 62) was compared to a long MI (LMI, n = 62) in uncomplicated patients. The choice of a SMI was not affected by technical issues and provided a significantly shorter TtFR (5 vs 6 days, p = 0.002) especially for pain control (4 vs. 5 days, p = 0.048) and oral food intake (5 vs. 6 days, p = 0.001).ConclusionFunctional recovery after open PD with MI is achieved within 1 week from surgery in half of the patients. This should be the appropriate benchmark for comparison with minimally invasive PD. Moreover, PD with a SMI is feasible, safe, and associated with a faster recovery.
Highlights
Pancreaticoduodenectomy (PD) is among the most complex surgical procedures in the field of gastrointestinal surgical oncology
Because the high postoperative management cost, rather than the cost of surgery, seems to be the main factor responsible for the high expense associated with elective PD [7, 8], the high costs of minimally invasive PD could soon be justified by the simultaneous reduction of expenses associated with postoperative hospitalization
According to the relative length of the midline incision (MI), we identified 138 (55.4%) patients with an short MIs (SMIs) and 111 (44.6%) with an long MIs (LMI)
Summary
Pancreaticoduodenectomy (PD) is among the most complex surgical procedures in the field of gastrointestinal surgical oncology. PD requires technically demanding resection and reconstruction phases that exhibit extreme variability, ranging from straightforward procedures to complex multivisceral resections that include venous and arterial resection [1, 2]. For these reasons, PD has always been managed with a traditional open approach. In the last 10 years, there has been flourishing research activity that has led to evidence that minimally invasive PD is at least associated with reduced blood loss, reduced hospitalization, and, a more rapid postoperative recovery than the classic open approach [5, 6]. Because the high postoperative management cost, rather than the cost of surgery, seems to be the main factor responsible for the high expense associated with elective PD [7, 8], the high costs of minimally invasive PD could soon be justified by the simultaneous reduction of expenses associated with postoperative hospitalization
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
