Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

Abstract

Background Laparoscopic pancreatoduodenectomy is a highly challenging procedure. The aim of this study was to analyse post-operative morbidity and mortality as well as long term overall survival in patients undergoing hybrid LPD, as compared to open pancreaticoduodenecomy (OPD) in a single surgeon series. Methods Patients undergoing pancreatoduodenectomy (PD) in the period from 2000 to 2015 were identified from a prospectively maintained database. All LPD procedures were performed by one specialised pancreatic surgeon (TK). Patients were matched 1 : 1 for age, sex, BMI, ASA, histological diagnosis, pancreatic texture and portal venous resection (PVR). All LPD procedures were performed as hybrid LPD – combining laparoscopic resection and open reconstruction via mini laparotomy. Results A total of 549 patients were identified, including 489 patients in the OPD group and 60 patients in the LPD group. 60 patients were identified who underwent LPD between 2010 and 2015 versus 60 OPD patients operated in the same period. Median overall operation time was shorter in the LPD group than with OPD patients (LPD 352 vs. OPD 397 min; p = 0.002). Overall transfusion units were lower in the LPD group (LPD range 0 – 4 vs. OPD range 0 – 11; p = 0.032). Intensive care unit stay (LPD 1 vs. OPD 6 d; p = 0.008) and overall hospital stay (OHS: LPD 14 vs. OPD 18 d; p = 0.012) were shorter in the LPD groups than in the OPD group. As regards postoperative complications, LPD was associated with reduced rates of clinically relevant grade B/C postoperative pancreatic fistula (LPD 15 vs. OPD 36%; p = 0.036) and grade B/C delayed gastric emptying (LPD 8 vs. OPD 20%; p = 0.049). A total of 56 patients were diagnosed with malignant disease. The number of harvested lymph nodes and R0-resection rates were equal for LPD and OPD patients. LPD patients showed a trend to improved median overall survival (LPD mean 56 months vs. OPD mean 48 months; p = 0.056). Conclusion Hybrid LPD is a safe procedure associated with a reduction in clinically relevant postoperative complications and allows faster recovery. Long term oncological outcome of hybrid LPD for malignant disease is equal to that with the standard open approach.

Long‐term oncologic outcomes of robotic and open pancreatectomy in a national cohort of pancreatic adenocarcinoma

“…Robotic pancreatic surgery using the da Vinci surgical system emerged as an alternative to laparoscopy in the middle of the last decade, and reports of its use began to proliferate in 2010. National data suggest this platform to be outpacing its laparoscopic counterpart in pancreatic resections due to perceived advantages of the technology and its relative ease of dissemination 2‐22 23,24 …”

Laparoscopic hybrid pancreaticoduodenectomy: Initial single center experience

“…The first question might be performing a total LPD 8,[12][13][14]22,23 or a hybrid-LPD. 11,16,17,20,21 It is true that the LPD is even more challenging especially during the reconstructive phase in particular with regard to pancreatic anastomosis. The absence of severe postoperative adhesion might enhance the risk of postoperative severe complications and in particular of POPF and hemorrhage.…”

Laparoskopische und robotische Pankreaschirurgie

“…Die hybrid-laparoskopische Pankreatoduodenektomie (HLPD) mit laparoskopischer Resektion und offener Rekonstruktion wird seltener durchgeführt [6,7]. Trotz der rekonstruktiven Minilaparotomie scheint die HLPD dieselben perioperativen Vorteile wie LPD und RPD gegenüber der OPD zu bieten, bei ebenfalls onkologischer Gleichwertigkeit.…”