A Case-matched Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy. Issue 3 (June 2020)

• Record Type: Journal Article
• Authors: Ammori, Basil J.; Omari, Balqees; Al Najjar, Hani; Abdullah, Niveen; Dabous, Ali; Daoud, Faiez; Almasri, Mahmoud
• Is Part Of: Surgical laparoscopy endoscopy & percutaneous techniques. Volume 30:Issue 3(2020)
• Publication Date: 2020-06
• Subjects: pancreaticoduodenectomy -- Whipple -- laparoscopic -- pancreatic cancer -- comparative study -- hospital stay; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Endoscopy -- Periodicals; Laparoscopy -- Periodicals; 617.550597
• DOI: 10.1097/SLE.0000000000000777
• Languages: English
• ISSNs: 1530-4515

Abstract

Abstract : Background: The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may offer benefits over open surgery [open pancreaticoduodenectomy (OPD)]. The aim of this study was to compare the outcomes of these 2 approaches at a tertiary cancer center from the Middle East. Materials and Methods: Fifty consecutive patients who underwent LPD (n=12) and OPD (n=38) between 2015 and 2018 were considered. One surgeon performed LPD for "all comers, " while 3 other surgeons performed open surgery. Patients were randomly matched on a 1:2 basis for pathology (benign vs. malignant), malignancy size (±1 cm), and whether the pancreatic duct was dilated (>3 mm). Results: Six patients were excluded, leaving 44 patients, of whom 33 were matched (LPD n=11, OPD n=22). The groups were comparable for age (57 vs. 63 y, P= 0.123) and sex distribution (female; 55% vs. 45%, P= 0.721), tumor size (3 cm in each group), frequency of pancreatic duct dilatation (45% in each group), and malignant pathology (82% in each group). There were no conversions to open surgery. Although the operating time for LPD was significantly longer (680 vs. 313 min, P <0.0001), LPD was associated with significantly shorter primary (4.7 vs. 7.8 d, P <0.0001) and total hospital stay that included readmissions (4.7 vs. 8.9 d, P <0.0001). There were no significant differences in blood loss (200 vs. 325 mL, P =0.082), overall complication rate (36.4% vs. 59.1%, P =0.282), or clinically significant complications (9.1% vs. 22.2%, P =0.643) and readmissions (0 vs. 4 patients). In patients with malignant disease, there were no differences with regard to the number of lymph nodes retrieved (18 vs. 12, P= 0.095) and frequency of R0 resections (77.8% in each group). Conclusion: In experienced hands, the laparoscopic approach to pancreaticoduodenectomy seems to offer advantages over open surgery in terms of reduction in hospital stay while maintaining an equivalent oncologic resection.