Single center experience of thirty five consecutive total duodenopancreatectomies

Abstract

Introduction: laparoscopic total duodenopancreatectomy (TLDPE) remains one of the colmplex procedures in minimally invasive abdominal surgery. Objective is to assess the short-term and long-term outcomes of TLDPE. Methods: 35 patients underwent TLDPE during last 10 years. 22 were females, 13 were males.30 patients were operated on because of malignancies and 5 because of benign diseases. Postoperative complications were assessed in order to evaluate the safety and feasibility of laparoscopic approach. Results: To date this is one of the largest single-center experiences of TLDPE. Mean operative time was 466 min and mean blood loss was 356 ml. The postoperative course of 22,8% of patients was complicated by Clavien-Dindo IIIa-V complication. Among them CD V - 5,7%. Mean ICU stay was 3,42 days, while mean hospital stay was 14 days. Rate of complications demanding repeat surgeries was 14,3%. Concomitant venous resection was performed in 10 cases. Venous resection was associated with higher blood loss and operation time. R0 resection was obtained in 97% of cases with mean number of lymph nodes harvested of 13. Median overall survival of patients with pancreatic cancer was 26 months with 5-years OSR of 29%. Mean maximum glucose level during the day was 9,8 mmol/l, HbAc 7,1 with mean demand in long-actin insulin 13,8 U. Median weight loss was 5 kg. One third of patients were complaining on diarrhea. Conclusion: TLDPE is feasible and effective procedure providing satisfactory short-terms and long-term outcomes.