Laparoscopic Assisted Pancreaticoduodenectomy Research Articles

Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis.

Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD). A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared. The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, p = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups. LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.

A Safe Start Laparoscopic-assisted Pancreaticoduodenectomy in Songklanagarind Hospital, Thailand: Case Report

Total laparoscopic pancreaticoduodenectomy (PD) is a highly complex procedure. Evidence suggests laparoscopic-assisted PD (LAPD) might be an important link in the process of transition from open PD to total laparoscopic PD. We present the first successful LAPD in a female patient with distal cholangiocarcinoma at Songklanagarind Hospital, Thailand in July 2018. The postoperative course was satisfactory without the clinical relevance of complications. No evidence of recurrence was found after 35 months of follow-up. The results ensured the feasibility and safety of LAPD in the initial phase; regarding both complications and oncological outcomes in a high-volume center for open PD.

Efficacy of laparoscopic-assisted pancreaticoduodenectomy in Vietnamese patients with periampullary of Vater malignancies: A single-institution prospective study

IntroductionMinimally invasive pancreaticoduodenectomy is a technically complex technique, that is being used to treat periampullary malignancy. We provide our experience with laparoscopic-assisted pancreaticoduodenectomy (LAPD) with statistics on the outcomes of periampullary cancer patients. Material and methodThirty patients underwent surgery between June 1, 2016 and May 30, 2020, with 21 undergoing classical PD and 9 undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). Prospectively gathered data on surgical outcomes and long-term oncological results are given. ResultsThe median operative time was 277.5 min (range, 258.7–330 min), and the median intraoperative estimated blood loss was 319.5 mL (range, 241.2–425 mL). The rate of conversion to OPD, surgical reintervention, and mortality was 20%, 13.3%, and 10% respectively. Cumulative surgery-related morbidity was 33.4%, including bleeding (n = 4), severe POPF (n = 4), biliary fistula (n = 1), DGE (n = 2), and intestinal obstruction (n = 1). Pathologic diagnoses were AoV cancer (n = 23), distal CBD cancer (n = 4), PDAC (n = 2), and AoV NET (n = 1). The mean survival time of the LAPD group was 29.9 months. The long-term survival time of the N0 group was 36.8 months, which was significantly longer than that of the N1 group. The long-term survival times of stages I–B, II-A, and II-B were 36.9, 26.5, and 15.7 months, respectively (p = 0.016). ConclusionLAPD has a high rate of conversion to OPD, morbidity, and mortality. However, LPD is feasible technique for highly selected patients. Lymph node metastasis and stage of disease are the risk factors for long-term survival.

Laparoscopic-assisted pancreaticoduodenectomy for periampullary cancer

Abstract Introduction: Laparoscopic pancreaticoduodenectomy is one of the most complicated major surgeries. The postoperative mortality and morbidity are still a burden of hepato-pancreato-biliary surgery. Aim of this study is to assess the short-term outcome of laparoscopic Whipple procedure for periampullary cancer. Materials and methods: Case series report. Results: From 1/2018 to 1/2019, we had performed laparoscopic Whipple procedure in 21 patients. The intracorporeal hepatico-jejunal anastomosis had been formed in all the cases. The pancreaticojejunal and gastro-jejunal anastomosis had been formed extracorporeally through small 5cm midline incision. The pancreatic duct had been drained with 8F drainage. The average operation time was 364 minutes. The average intraoperation blood loss was 175ml. Postoperative mean length of stay was 12.1 days. Pancreaticojejunal anastomosis accounted for 19,0%. Postoperative bleeding occurred in 2 patient (9%) whom were converted to open surgery for control bleeding. In our series, there was no postoperative mortality. Conclusions: Laparoscopic-assisted pancreaticoduodenectomy is safe with low postoperative morbidity and mortality. This procedure is feasible for treatment of periampullary cancer.

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

BackgroundThe safety of total laparoscopic pancreaticoduodenectomy still remains controversial. Laparoscopic assisted pancreaticoduodenectomy (LAPD) may be an alternative selection. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon.MethodsA comparison was conducted between LAPD and OPD from January 2013 to December 2018. Perioperative outcomes and short-term oncological results were compared. Univariate and multivariable analyses were performed to determine associations among variables.Results133 patients were enrolled, 36 patients (27.1%) underwent LAPD and 97 (72.9%) underwent OPD. No 30-day and 90-day mortality occurred. LAPD was associated with decreased intraoperative estimated blood loss (300 versus 500 ml; P = 0.002), longer operative time (372 versus 305 min; P < 0.001) compared with OPD. LAPD had a conversion rate of 16.7%, and wasn’t associated with an increased grade B/C pancreatic fistula rate, major surgical complications, intraoperative blood transfusion, reoperation rate or length of hospital stay after surgery. In the subset of 58 pancreatic ductal adenocarcinomas, R0 resection rate, median total harvested lymph node or lymph nodes ≥12 did not differ between the two groups.ConclusionLAPD could be performed with non-inferior short-term perioperative and oncologic outcomes achieved by OPD in selected patients.

Early feeding after laparoscopic assisted pancreatico-duodenectomy with pancreatico-gastric anastomosis

Early feeding after laparoscopic assisted pancreatico-duodenectomy with pancreatico-gastric anastomosis

Laparoscopic pancreatic resections: review of feasibility, safety and outcome

Pancreatico-duodenectomy and distal pancreatectomy are the curative resections for pancreatic malignancies. Minimal access resections will reduce the exposure incision whilst facilitating resection with a clear vision. However surgeon faces a challenging learning curve which is less steep for distal resection compared to pancreaticoduodenectomy. In laparoscopic pancreatico-duodenectomy resection and anastomosis will be done by laparoscopy. In laparoscopic assisted pancreatico-duodenectomy some or all the anastomoses are performed by a mini-laparotomy. In the case series presented three distal pancreatectomies were performed without conversion. Twenty three out of thirty two (74%) pancreatico-duodenectomies were converted to open at various stages of resection. Five had complete mobilization, four had complete resection and minilaparotomy anastomosis. One out of the four had the hepatico-jejunostomy performed laparoscopically. He had a pancreatico-gastrostomy and gastro-jejunostomy by a mini-laparotomy with an incision of about 5cm. Early feeding and mobilization was possible with analgesic requirement being minimal. Two patients died with in one month in the pancreaticoduodenectomy group recording a mortality of 6%. Except one all had clear resection margins on histo-pathology with lymph node clearance comparable to open surgery. In units performing open pancreatic surgery and conversant with advanced laparoscopy, going through the learning curve for laparoscopic pancreatic surgery is feasible and safe. To compare benefits over the open procedures warrant further recruitment of patients

Analysis of learning curve for laparoscopic pancreaticoduodenectomy.

Laparoscopic pancreaticoduodenectomy (LPD) may have potential minimal invasive advantages for selected patients in limited center. However, few studies analyzed the learning curve. This study aimed to analyze the learning curve of this procedure at a large volume set, and share our experience to surmount it. All prospectively maintained data of the consecutive LPDs was reviewed retrospectively. The procedures were performed by single surgeon. Patients were divided into four groups according to staged approach with different focuses: Group A (the first 30 patients), Group B (the second 30 patients), Group C (the third 30 patients), and Group D (the fourth and last 30 patients). And the changes of outcomes during different learning periods were analyzed. Between September 2012 and July 2015, 120 patients underwent LPD. One hundred and eleven of them underwent totally LPD, and 9 patients underwent laparoscopic assisted pancreaticoduodenectomy (LAPD). The mean operative time (OT), mean blood loss and average length of hospital stay (LOS) was 359.8±57.6 min, 169.7±152.6 mL and 17.0±9.8 d respectively. A total of 42 (35%) patients developed morbidity with no mortality. The mean overall OT tended to decrease from 370.2±52.8 min in Group A to 342.0±73.1 min in Group D with the accumulating experience of the surgeon. Moreover, mean OT of pancreatojejunostomy and choledochojejunostomy also tended to decrease from 55.0±8.7, 39.8±11.7 min in Group A to 43.6±7.6, 27.7±11.8 min in Group D respectively. Meanwhile, the clinical outcomes tended to get better. Mean blood loss, morbidity and LOS decreased from 219.3±147.9 mL, 43.3%, 18.7±10.0 d in Group A to 140.1±73.6 mL, 23.3%, 14.4±6.2 d in Group C respectively except for Group D. Routine practice of the LPD procedure was feasible and safe. Gained experience can improve clinical outcomes in 30 to 60 operations by overcoming the learning curve.

Getting Started with Minimally Invasive Pancreaticoduodenectomy: Is It Worth It?

This study evaluates the safety and cost of introducing minimally invasive pancreaticoduodenectomy (MIPD) to a surgeon's practice. All MIPDs performed between December 2011 and July 2013 were compared with open pancreaticoduodenectomy (OPD) cases by the same surgeon. The primary outcomes were mortality, major morbidity, and re-operation. Secondary outcomes were perioperative and oncologic outcomes and cost. MIPD include total laparoscopic pancreaticoduodenectomy (TLPD) and laparoscopic-assisted pancreaticoduodenectomy (LAPD), where a small incision is used for reconstruction. Bivariate comparisons of outcomes were performed using nonparametric tests. In total, 44 pancreaticoduodenectomies were performed: 15 MIPDs (2 TLPDs and 13 LAPDs) and 29 OPDs. One death occurred in each group. Major complication rates were not significantly different (33% for MIPD versus 17% for OPD); however, there was a trend toward more re-operation after MIPD compared with OPD (20% versus 3%; P = .07). The incidence of pancreatic leak (20% for MIPD versus 14% for OPD), biliary leak (0% versus 7%, respectively), abscess formation (27% versus 14%, respectively), and intraabdominal hemorrhage (13% versus 3%, respectively) were not significantly different. MIPD achieved equivalent oncologic outcomes as OPD with 100% R0 margin and adequate lymph node retrieval. There was no statistical difference in median operative time (342 minutes for MIPD versus 358 minutes for OPD), length of stay (8 versus 9 days, respectively), operating room expenses (Canadian) ($7246.0 versus $6912.0, respectively), or total cost (Canadian) per case ($15,034.0 versus $18,926.0, respectively). MIPD and OPD had similar safety and cost in this introductory series. However, a trend toward a higher rate of re-operation for pancreatic leak suggests the need for caution in introducing this novel technique.

Laparoscopic-assisted versus open pancreaticoduodenectomy: Early favorable physical quality-of-life measures

We compared outcomes and postpancreatectomy quality of life (QOL) in paired cohorts of patients undergoing conventional open pancreaticoduodenectomy (OPD) or laparoscopic-assisted pancreaticoduodenectomy (LAPD). Comparative analysis of QOL was performed in a matched cohort of 53 patients after OPD or LAPD between 2010 and 2013. The Medical Outcomes Study Short Form-36 Health Survey and the Karnofsky score were used. Physical component score, mental component score, and Karnofsky scores were calculated at multiple time points for OPD (n = 25) and LAPD (n = 28). Operative times, complications, and readmission rates were equivalent. Time to starting adjuvant therapy trended toward clinical importance in LAPD (61 vs 110 days, P = .0878). Duration of stay was less in LAPD (7.10 vs 9.44 days, P = .02). LAPD had a superior QOL centered on functional status compared with OPD (physical component score 49.09 vs 38.4, P = .04; Karnofsky 92.22 vs 66.92%, P = .003). These statistical differences were not observed beyond 6 months. LAPD provided a more favorable QOL within the first 6 months and shorter length of stay compared with conventional OPD. LAPD may serve as an alternative operative therapy to potentially minimize delays in receipt of and enhance tolerability of adjuvant therapies.