Comparison of Laparoscopic and Open Pancreaticoduodenectomy for the Treatment of Nonpancreatic Periampullary Adenocarcinomas

Abstract

Background:Laparoscopic pancreaticoduodenectomy (LPD), a surgical option for nonpancreatic periampullary adenocarcinoma (NPPA), is a complex procedure that has become increasing popular. However, there is no consensus as to whether this technique should be performed routinely. Our aim was to evaluate the outcomes of LPD compared with open pancreaticoduodenectomy (OPD).Materials and Methods:From October 2010 to September 2015, 58 LPDs were performed to treat NPPA and were compared with 58 OPDs, which can theoretically be carried out by laparoscopic approach. Patients were also matched based on their demographic data and pathologic diagnosis. Demographic information, intraoperative and postoperative data, pathologic data, and follow-up evaluation data were collected at our center.Results:All patients had a median follow-up of 34 months (range, 8 to 60 mo). Overall median survival during the study between the groups was not different (P=0.760). No significant differences between the 2 groups were found in terms of patient demographics, short-term complications, pathologic outcomes, or tumor-node-metastasis stage. With regard to operative time, the LPD group was slightly longer than the OPD group (P<0.001). There were significant differences between groups in the time to the first passage of flatus and the time to oral intake (P<0.001). However, no differences were seen in blood loss, length of intensive care unit stay, node positive, or R0 resection between the laparoscopic and open groups.Conclusions:This study found that LPD is a feasible, safe, and effective method for the treatment of NPPA compared with OPD and may be a preferred method for surgeons to choose.

Expanding laparoscopic pancreaticoduodenectomy to pancreatic-head and periampullary malignancy: major findings based on systematic review and meta-analysis

“…Another two publications were then excluded due to overlapping patient cohorts [ 12 , 13 ]. Finally, a total of 9443 patients [LPD 1196 (12.7%), OPD 8247 (87.3%)] from 11 studies were included [ 14 – 24 ]. Figure 1 illustrates the selection process.…”

“…Only one RCR was found [ 22 ]. The indication of six studies was PDAC [ 14 , 16 – 20 ], whereas two studies applied LPD only to PAAC [ 15 , 24 ], the remaining three researches reported both PDAC and PAAC [ 21 – 23 ]. Table 1 lists the characteristics of these studies and details of the enrolled participants.…”

“…POPF was described in 8 studies [ 14 , 15 , 18 , 19 , 21 – 24 ]. Pooling data indicated no significant difference in terms of overall POPF rates between two groups (OR = 0.85, 95%CI: 0.59~ 1.24, P = 0.40) (Fig.…”

Laparoscopic pancreaticoduodenectomy; Single-surgeon experience

“…Some studies have shown that laparoscopic pancreaticoduodenectomy is better than open pancreaticoduodenectomy. [14] However, some studies reported that laparoscopic pancreaticoduodenectomy is a difficult procedure associated with a high morbidity. They concluded that laparoscopic pancreaticoduodenectomy should not be used routinely for resection of periampullary tumors.…”

“…They concluded that laparoscopic pancreaticoduodenectomy should not be used routinely for resection of periampullary tumors. [14] Meng et al [14] reported that laparoscopic pancreaticoduodenectomy is a feasible, effective and safe method for the treatment of nonpancreatic periampullary adenocarcinoma which may be used as an alternative to open pancreaticoduodenectomy. In our study, dissection was easier in a patient with an ampullary tumor.…”