Early National Experience with Laparoscopic Pancreaticoduodenectomy for Ductal Adenocarcinoma: A Comparison of Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy from the National Cancer Data Base

Sharpe, Susan; Talamonti, Mark S.; Wang, Chihsiung E.; Prinz, Richard A.; Roggin, Kevin K.; Bentrem, David J.; Winchester, David J.; Marsh, Robert de Wilton; Stocker, Susan J.; Baker, Marshall S.

doi:10.1016/j.jamcollsurg.2015.04.021

Cited by 184 publications

(141 citation statements)

References 20 publications

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“…In general, the reconstruction time and clinical outcomes improved mostly after 30 to 60 cases by routine practice, and we concluded that such number was essential to get experienced rather than ten cases as supposed (20), which we believed to represent the difficult beginning phase. As shown, we successfully performed LPDs with staged approach with slower but continuous improvements, just as the plateau phase.…”

Section: Discussionmentioning

confidence: 83%

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Lü¹,

Jin²,

Mou³

et al. 2016

J. Vis. Surg.

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Section: Discussionmentioning

confidence: 83%

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Lü¹,

Jin²,

Mou³

et al. 2016

J. Vis. Surg.

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“…Additionally, a selection bias cannot be ignored in this analysis. There were no increases in mortality rates reported by high-volume centers 20 . Regrettably, the selection criteria were not shown in most of the included studies.…”

Section: Discussionmentioning

confidence: 75%

“…Furthermore, there were few potential confounding factors listed in several studies 19, 20, 25, 26 . Therefore, the results of this meta-analysis should be interpreted carefully because of the potential confounding factors, and further studies that are well-adjusted for confounds are needed.…”

Section: Discussionmentioning

confidence: 99%

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A systemic review and an updated meta-analysis: minimally invasive vs open pancreaticoduodenectomy

Zhao

Yin

Hang

et al. 2017

Sci Rep

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The feasible of minimally invasive pancreaticoduodenectomy (MIPD) remains controversial when compared with open pancreaticoduodenectomy (OPD). We conducted a systemic review and meta-analysis to summarise the available evidence to compare MIPD vs OPD. We systemically searched PubMed, EMBASE and Web of Science for studies published through February 2016. The primary endpoint was postoperative pancreatic fistula (POPF, grade B/C). A total of 27 studies involving 14,231 patients (2,377 MIPD and 11,854 OPD) were included. MIPD was associated with longer operative times (P < 0.01) and increased mortality (P < 0.01), but decreased estimated blood loss (P < 0.01), decreased delayed gastric emptying (P < 0.01), increased R0 resection rate (P < 0.01), decreased wound infection (P = 0.03) and shorter hospital stays (P < 0.01). There were no significant differences in BMI (P = 0.43), tumor size (P = 0.17), lymph nodes harvest (P = 0.57), POPF (P = 0.84), reoperation (P = 0.25) and 5-year survival rates (P = 0.82) for MIPD compared with OPD. Although there was an increased operative cost (P < 0.01) for MIPD compared with OPD, the postoperative cost was less (P < 0.01) with the similar total costs (P = 0.28). MIPD can be a reasonable alternative to OPD with the potential advantage of being minimally invasive. However, MIPD should be performed in high-volume centers and more randomized-controlled trials are needed to evaluate the appropriate indications of MIPD.

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“…However, the definitive benefits of a minimally invasive approach (laparoscopic or robotic) to pancreaticoduodenectomy (Whipple procedure) continue to be debated (10,(16)(17)(18). Nevertheless, it appears reasonable to speculate that some of the advantages seen with the use of a minimally invasive approach to distal pancreatectomy may be applicable to a TLP.…”

Section: Introductionmentioning

confidence: 99%

Total laparoscopic pancreaticoduodenectomy

et al. 2016

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Total laparoscopic pancreaticoduodenectomy (TLP) represents perhaps one of the most challenging abdominal operations. This procedure is gaining popularity in recent years, mostly due to the numerous reports underling its safety and feasibility in the setting of several benign and malignant pancreatic pathologies. Minimal-invasive pancreatic surgery is rapidly becoming a reality in many centers around the globe and its benefits, compared to the traditional open approach, have been extensively proven in the setting of distal pancreatic resection. The many advantages of a laparoscopic approach, such as the improved visual magnification, the theoretical improved tissue exposure, and the potential for a more delicate manipulation of tissues are reasonably expected to be applicable to other pancreatic procedures including TLP. Herein we describe a technique for a TLP; we provide some suggestions on patient selection, pre-operative preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure. preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure. Patient selection and workupMost patients with pancreatic, ampullary, or biliary pathologies who require a pancreaticoduodenectomy are eligible for a laparoscopic approach. One limitation is represented by patients with locally advanced pathologies (i.e., locally advanced pancreatic adenocarcinoma) with involvement of the mesenteric vasculature due to the inherent technical difficulties represented by the need for laparoscopic vascular resection and reconstruction (although a few specialized centers occasionally offer TLP in this setting) (11,19).The authors routinely obtain preoperative multi-slice pancreas specific triple-phase (i.e., arterial, late arterial, and venous phase) computed tomography in order to properly evaluate the pancreatic gland and its spatial relation with the surrounding organs and vasculature; particular attention is given to the evaluation for any aberrant anatomy (e.g., replaced or accessory hepatic vasculature).Additional imaging is dictated by the particular pancreatic pathology that is being addressed, and can vary from endoscopic retrograde cholangiopancreatography with or without pancreatic duct brushing, endoscopic pancreatic ultrasound with or without fine needle aspiration, and magnetic resonance imaging.Preoperative laboratory tests are routinely obtained and include a complete blood cell count, a complete metabolic panel (CMP), a coagulation profile, and in case of a patient with known preexisting diabetes glycated hemoglobin level is assessed; specific tumors markers are obtained based on the pathology being treated. Pre-operative preparationPatients selected to undergo a TLP meet preoperatively with a nutritionist and a glucose management expert, this provides an initial overview on the life style and diet adjustments that are necessary following the procedure. Furthermore, t...

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Early National Experience with Laparoscopic Pancreaticoduodenectomy for Ductal Adenocarcinoma: A Comparison of Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy from the National Cancer Data Base

Cited by 184 publications

References 20 publications

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

A systemic review and an updated meta-analysis: minimally invasive vs open pancreaticoduodenectomy

Total laparoscopic pancreaticoduodenectomy

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