Practice Patterns and Perioperative Outcomes of Laparoscopic Pancreaticoduodenectomy in China

Abstract

Objective: The aim of the study was to analyze the outcomes of patients who have undergone laparoscopic pancreaticoduodenectomy (LPD) in China. Summary Background Data: LPD is being increasingly used worldwide, but an extensive, detailed, systematic, multicenter analysis of the procedure has not been performed. Methods: We retrospectively reviewed 1029 consecutive patients who had undergone LPD between January 2010 and August 2016 in China. Univariate and multivariate analyses of patient demographics, changes in outcome over time, technical learning curves, and the relationship between hospital or surgeon volume and patient outcomes were performed. Results: Among the 1029 patients, 61 (5.93%) required conversion to laparotomy. The median operation time (OT) was 441.34 minutes, and the major complications occurred in 511 patients (49.66%). There were 21 deaths (2.43%) within 30 days, and a total of 61 (5.93%) within 90 days. Discounting the effects of the early learning phase, critical parameters improved significantly with surgeons’ experience with the procedure. Univariate and multivariate analyses revealed that the pancreatic anastomosis technique, preoperative biliary drainage method, and total bilirubin were linked to several outcome measures, including OT, estimated intraoperative blood loss, and mortality. Multicenter analyses of the learning curve revealed 3 phases, with proficiency thresholds at 40 and 104 cases. Higher hospital, department, and surgeon volume, as well as surgeon experience with minimally invasive surgery, were associated with a lower risk of surgical failure. Conclusions: LPD is technically safe and feasible, with acceptable rates of morbidity and mortality. Nonetheless, long learning curves, low-volume hospitals, and surgical inexperience are associated with higher rates of complications and mortality.

Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia

“…The adoption of minimally-invasive pancreatic and biliary surgery (MIPBS) is increasing rapidly throughout the world today. [ 1 2 3 4 5 ] However, MIPBS remains a highly complicated and technically demanding procedure and large series of minimally-invasive pancreato surgery (MIPS) and minimally-invasive biliary surgery (MIBS) remain limited to a few early adopting and pioneering expert centres from North America,[ 6 7 ] Europe[ 8 9 10 ] and certain parts of Asia including North Asia[ 2 4 11 12 ] and the Indian subcontinent. [ 3 13 ] At present, there are only a few studies from Southeast Asia reporting on MIPBS which were mainly published from our centre.…”

Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia

“…MIPS was first reported more than 2 decades ago by Gagner et al . [ 3 ] Since then, several large series from throughout the world including North America, North Asia and Europe[ 1 12 23 24 25 33 34 ] reporting on MIPD and MIDP have been published. However, to date, the adoption and development of MIPS in other parts of the world such as Southeast Asia has not been well-described.…”

Total laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy (TJDBPS01): study protocol for a multicentre, randomised controlled clinical trial

“…The TJDBPS01 trial is designed as a multicentre, randomised, controlled, superiority trial with two parallel groups in 14 pancreatic centres among 11 provinces in China, providing a minimum of >50 PDs annually (online supplementary file 1). All the participating 14 centres with pancreatic surgery expertise have performed ≥104 TLPDs and OPDs, respectively 15. Screening and identification of eligible patients will take place within the participating centres’ pancreatic multidisciplinary team (MDT).…”