Background: The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may offer benefits over open surgery [open pancreaticoduodenectomy (OPD)]. The aim of this study was to compare the outcomes of these 2 approaches at a tertiary cancer center from the Middle East. Materials and Methods: Fifty consecutive patients who underwent LPD (n=12) and OPD (n=38) between 2015 and 2018 were considered. One surgeon performed LPD for “all comers,” while 3 other surgeons performed open surgery. Patients were randomly matched on a 1:2 basis for pathology (benign vs. malignant), malignancy size (±1 cm), and whether the pancreatic duct was dilated (>3 mm). Results: Six patients were excluded, leaving 44 patients, of whom 33 were matched (LPD n=11, OPD n=22). The groups were comparable for age (57 vs. 63 y, P=0.123) and sex distribution (female; 55% vs. 45%, P=0.721), tumor size (3 cm in each group), frequency of pancreatic duct dilatation (45% in each group), and malignant pathology (82% in each group). There were no conversions to open surgery. Although the operating time for LPD was significantly longer (680 vs. 313 min, P<0.0001), LPD was associated with significantly shorter primary (4.7 vs. 7.8 d, P<0.0001) and total hospital stay that included readmissions (4.7 vs. 8.9 d, P<0.0001). There were no significant differences in blood loss (200 vs. 325 mL, P=0.082), overall complication rate (36.4% vs. 59.1%, P=0.282), or clinically significant complications (9.1% vs. 22.2%, P=0.643) and readmissions (0 vs. 4 patients). In patients with malignant disease, there were no differences with regard to the number of lymph nodes retrieved (18 vs. 12, P=0.095) and frequency of R0 resections (77.8% in each group). Conclusion: In experienced hands, the laparoscopic approach to pancreaticoduodenectomy seems to offer advantages over open surgery in terms of reduction in hospital stay while maintaining an equivalent oncologic resection.
Background Patients with head and neck cancers may require feeding tube gastrostomy (FTG) during their treatment. Surgical gastrostomy is indicated in patients who fail or unsuitable for endoscopic or radiologic FTG insertion. Objective The aim of this study was to compare the outcomes of a novel laparoscopic technique to the insertion of feeding tube gastrostomy (FTG) in patients with head and neck cancer vs conventional open surgery. Methods Patients were randomly matched on a 1:1 basis according to whether the procedure was therapeutic or prophylactic and whether a concomitant less major surgical procedure was required. Results The groups (17 patients in each group) were comparable for age, sex distribution, ASA score, body mass index, serum albumin levels and the frequencies of previous upper abdominal surgery, hypoalbuminaemia and prior chemoradiotherapy and/or cancer surgery. There were no conversions to open surgery. No significant differences were detected between the groups with regard to the operating time (median, 40 vs 60 minutes, P = .053) and 30‐day clinically significant morbidity (17.6% vs 23.5%, P = .180) or mortality (11.8% in each group). However, laparoscopy was associated with significantly shorter hospital stay (0 vs 2.8 days, P < .001) and greater proportion of day‐case procedures (64.7% vs 0%, P < .001). Conclusions Laparoscopic insertion of FTG is safe, can be performed as a day‐case procedure, and is associated with shorter hospital stay compared with open surgery; it should be preferred over open surgery where local expertise exists.
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