Laparoscopic pancreatoduodenectomy with open or laparoscopic reconstruction during the learning curve: a multicenter propensity score matched study. Issue 7 (July 2019)

• Record Type: Journal Article
• Authors: van Hilst, Jony; de Rooij, Thijs; van den Boezem, Peter B.; Bosscha, Koop; Busch, Olivier R.; van Duijvendijk, Peter; Festen, Sebastiaan; Gerhards, Michael F.; de Hingh, Ignace H.; Karsten, Tom M.; Kazemier, Geert; Lips, Daniel J.; Luyer, Misha D.; Nieuwenhuijs, Vincent B.; Patijn, Gijs A.; Stommel, Martijn W.; Zonderhuis, Babs M.; Daams, Freek; Besselink, Marc G.
• Is Part Of: HPB. Volume 21:Issue 7(2019)
• Page Start: 857
• Page End: 864
• Publication Date: 2019-07
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2018.11.003
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Laparoscopic pancreatoduodenectomy with open reconstruction (LPD-OR) has been suggested to lower the rate of postoperative pancreatic fistula reported after laparoscopic pancreatoduodenectomy with laparoscopic reconstruction (LPD). Propensity score matched studies are, lacking. Methods: This is a multicenter prospective cohort study including patients from 7 Dutch centers between 2014–2018. Patients undergoing LPD-OR were matched LPD patients in a 1:1 ratio based on propensity scores. Main outcomes were postoperative pancreatic fistulas (POPF) grade B/C and Clavien-Dindo grade ≥3 complications. Results: A total of 172 patients were included, involving the first procedure for all centers. All 56 patients after LPD-OR could be matched to a patient undergoing LPD. With LPD-OR, the unplanned conversion rate was 21% vs. 9% with LPD ( P < 0.001). Median blood loss (300 vs. 400 mL, P = 0.85), operative time (401 vs. 378 min, P = 0.62) and hospital stay (10 vs. 12 days, P = 0.31) were comparable for LPD-OR vs. LPD, as were Clavien-Dindo grade ≥3 complications (38% vs. 52%, P = 0.13), POPF grade B/C (23% vs. 21%, P = 0.82), and 90-day mortality (4% vs. 4%, P > 0.99). Conclusion: In this propensity matched cohort performed early in the learning curve, no benefit was found for LPD-OR, as compared to LPD.