Matched Case-control Analysis Comparing Laparoscopic and Open Pylorus-preserving Pancreaticoduodenectomy in Patients With Periampullary Tumors

Song, Ki Byung; Kim, Song Cheol; Hwang, Dae Wook; Lee, Jae Hoon; Lee, Dong Joo; Lee, Jung Woo; Park, Kwang-Min; Lee, Young‐Joo

doi:10.1097/sla.0000000000001079

Cited by 184 publications

(182 citation statements)

References 22 publications

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“…Studies suggest the minimally invasive approach is not only feasible but equivalently efficacious and safe: with similar perioperative morbidity and mortality (6)(7)(8)(9)(10)(15)(16)(17)(18)(19). In particular, the minimally invasive approach to distal pancreatectomy has been widely accepted and clearly demonstrated advantages such as reduced blood loss, reduced overall complication rate, reduced surgical site infection and shorter hospital length of stay (7)(8)(9)(10)17).…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopy, particularly in the setting of benign disease, is being increasingly utilized for pancreatic surgery. Limited pancreatectomy (pancreaticoduodenectomy or distal pancreatectomy), for example, when performed by experienced surgeons has been demonstrated to be safe, produce similar outcomes at equal or lesser cost, and lead to decreased length of hospital stay when compared to open pancreatectomy (6)(7)(8)(9)(10). The generalization of these findings to TP appears appropriate (as one of the most technically challenging hurdles in pancreaticoduodenectomy, the pancreaticojejunal anastomosis, is eliminated in TP) and is now being utilized in select centers.…”

Section: Original Article On Pancreatic Surgerymentioning

confidence: 99%

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Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

et al. 2016

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Background: Pain from chronic pancreatitis can be debilitating and have far-reaching personal and societal consequences. These consequences can include patient debilitation, worsening of comorbid conditions, narcotic dependence, and implications for health care policy. A variety of surgical procedures have shown limited efficacy for relieving pain in this cohort of patients, and a highly select subset may benefit from a total pancreatectomy (TP). While a brittle form of diabetes can result from TP alone, when combined with islet cell autotransplantation this procedural complication can be minimized. Further, utilizing a minimally invasive approach may be associated with decreased periprocedural pain and length of hospital stay.Methods: We describe our experience at a single high-volume center in the United States. We present our preferred preoperative evaluation, our updated operative techniques, and the standard perioperative care required following this complex laparoscopic procedure.Results: Between 2013 and 2015, there were 20 patients who underwent laparoscopic total pancreatectomy with islet autotransplantation (LTPIAT). Perioperative mortality was 0%.Conclusions: At a high volume pancreatic center with experienced laparoscopic pancreatic surgeons, LTPIAT is feasible and safe for the management of chronic pancreatitis refractory to prior medical and surgical therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Original Article On Pancreatic Surgerymentioning

confidence: 99%

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

et al. 2016

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“…As operative techniques and peri-operative outcomes continue to improve, optimizing the eligibility criteria for resection is of great interest. 6,8 Furthermore, due to limited survival times, identifying those patients who do not benefit from a resection is equally important.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: A systematic review and meta-analysis

et al. 2016

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“…Since then, several single institution series reported on the safety and feasibility of TLP in the setting of several benign and malignant pancreatic pathologies (2)(3)(4). The available literature mainly focuses on two key aspects of TLP, one being the learning curve necessary to master the procedure and the other being the comparison of overall outcomes between TLP and open pancreaticoduodenectomy (OPD) (5)(6)(7). The numerous studies that have focused on TLP learning curve have identified at least three phases: a slow difficult beginning, followed by a rapid improvement that culminates in a plateau phase characterized by a slow but continuous improvement (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…The available literature mainly focuses on two key aspects of TLP, one being the learning curve necessary to master the procedure and the other being the comparison of overall outcomes between TLP and open pancreaticoduodenectomy (OPD) (5)(6)(7). The numerous studies that have focused on TLP learning curve have identified at least three phases: a slow difficult beginning, followed by a rapid improvement that culminates in a plateau phase characterized by a slow but continuous improvement (5)(6)(7). Moreover, most studies comparing TLP to OPD suggest that when TLP is performed in center of expertise the oncologic outcome, the complication rate, and the mortality rate are similar to OPD.…”

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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Matched Case-control Analysis Comparing Laparoscopic and Open Pylorus-preserving Pancreaticoduodenectomy in Patients With Periampullary Tumors

Abstract: L-PPPD had the typical advantages of minimally invasive abdominal procedures, such as less pain, shorter hospital stay, and quicker recovery. It is technically safe and feasible, and has favorable oncologic outcomes in comparison with O-PPPD in patients with periampullary tumors.

Cited by 184 publications

References 22 publications

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: A systematic review and meta-analysis

Total laparoscopic pancreaticoduodenectomy

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