Preliminary experience of laparoscopic pancreatoduodenectomy in 14 cases

Abstract

Objective To investigate the feasibility and safety of laparoscopic pancreatoduodenectomy (LPD). Methods Clinical data of 14 patients undergoing LPD in the Third Affiliated Hospital of Sun Yat-sen University from February 2017 to January 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 6 patients were male and 8 female, aged 49-72 years with a median age of 63 years. Peri-ampullar tumors were confirmed by preoperative imaging examination, with an average diameter of (2.7±0.7) cm. Intraoperative and postoperative complications were analyzed. Results 12 patients underwent standard total LPD, 1 patient received LPD combined with left hemihepatectomy, and 1 patient was converted to laparotomy for pancreaticogastrostomy for the pancreatic duct could not be found due to atrophy. The operation time was (547±66) min. The intraoperative blood loss was (145±58) ml. The length of postoperative hospital stay was (14±7) d. Postoperative pancreatic fistula occurred in 2 cases, abdominal hemorrhage in 1, gastrointestinal hemorrhage in 1 and intestinal obstruction in 1, respectively. Postoperative pathological examination indicated that 6 cases were with lower common bile duct carcinoma, 5 cases with peri-ampullary carcinoma, 2 cases with pancreatic uncinate process carcinoma and 1 case with pancreatic uncinate process mucinous cystadenoma, respectively. Conclusions LPD has the advantages of small trauma and rapid recovery after operation. The learning curve of LPD is relatively long. In the early stage of performing LPD, it is suitable to select patients with small peri-ampullary tumors. It is safe and feasible to perform LPD by the operators with laparoscopic technique and experience. Key words: Laparoscopes; Pancreaticoduodenectomy; Periampullary tumor; Pancreatic fistula