Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic pancreaticoduodenectomy: single-surgeon experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Innovations in surgical strategies and technologies have facilitated laparoscopic pancreaticoduodenectomy (LPD). However, data regarding the short-term and long-term results of LPD are sparse, and this procedure is the primary focus of the current study.

Methods

Between October 2010 and October 2013, a total of 31 consecutive patients received LPD, including hand-assisted laparoscopic pancreaticoduodenectomy, total laparoscopic pancreaticoduodenectomy, and laparoscopic pylorus-preserving pancreaticoduodenectomy. Data regarding short-term surgical outcomes and long-term oncological results were collected prospectively.

Results

The median operative time was 515.0 min (interquartile range 465.0–585.0 min). The median intraoperative estimated blood loss was 260.0 mL (interquartile range 150.0–430.0 mL). Conversion to open pancreaticoduodenectomy was required in three patients (9.7 %) due to intraoperative pneumoperitoneum intolerance (n = 1, 3.2 %) and tumor adherence to the superior mesenteric vein (n = 2, 6.5 %). No significant differences between the surgical approaches were observed in regard to intraoperative and postoperative data. Postoperative severe complications (Clavien ≥ III) were detected in three (9.7 %) patients, including one grade C pancreatic fistula, one grade B postoperative bleeding event, and one afferent loop obstruction. There were no deaths within 30 days following LPD. The final pathological results revealed duodenal adenocarcinoma in 14 (45.2 %) patients, ampullary adenocarcinoma in four (12.9 %) patients, distal common bile duct cancer in six (19.4 %) patients, pancreatic ductal adenocarcinoma in five (16.1 %) patients, gastrointestinal stroma tumor in one (3.2 %) patient, and chronic pancreatitis in one (3.2 %) patient. All patients suffering from tumors underwent R0 resection (n = 30, 100.0 %), with the optimal number of collected lymph nodes (median: 13, interquartile range 11–19). At the most recent follow-up, 20 patients were still alive, and the 1-, and 3-year overall survival for patients with duodenal adenocarcinoma were 100.0 and 71.4 %, respectively.

Conclusions

According to this study, LPD is feasible and technically safe for highly selected patients and can offer acceptable oncological outcomes and long-term survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fernandez-Cruz L, Saenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S (2002) Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 26:1057–1065

    Article  CAS  PubMed  Google Scholar 

  2. Ammori BJ, Ayiomamitis GD (2011) Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc 25:2084–2099

    Article  PubMed  Google Scholar 

  3. Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF, Hepatobiliary, Pancreatic Section of the Royal Belgian Society of S, Belgian Group for Endoscopic S, Hepatobiliary Club C (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605

    Article  PubMed  Google Scholar 

  4. Hall NJ, Pacilli M, Eaton S, Reblock K, Gaines BA, Pastor A, Langer JC, Koivusalo AI, Pakarinen MP, Stroedter L, Beyerlein S, Haddad M, Clarke S, Ford H, Pierro A (2009) Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet 373:390–398

    Article  PubMed  Google Scholar 

  5. Wei CH, Fu YW, Wang NL, Du YC, Sheu JC (2015) Laparoscopy versus open surgery for idiopathic intussusception in children. Surg Endosc 29:668–672

    Article  PubMed  Google Scholar 

  6. Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, Okutomi T, Wang G, Bax L (2013) Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc 27:1695–1705

    Article  PubMed  Google Scholar 

  7. Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410

    Article  CAS  PubMed  Google Scholar 

  8. Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, Ferrari GC, Di Lernia S, Magistro C (2008) Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech 18:13–18

    Article  PubMed  Google Scholar 

  9. Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg 1:20–25; discussion 25–26

  10. Gumbs AA, Gres P, Madureira FA, Gayet B (2008) Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg 12:707–712

    Article  PubMed  Google Scholar 

  11. Gentileschi P, Gagner M (2001) Laparoscopic pancreatic resection. Chir Ital 53:279–289

    CAS  PubMed  Google Scholar 

  12. Kimura Y, Hirata K, Mukaiya M, Mizuguchi T, Koito K, Katsuramaki T (2005) Hand-assisted laparoscopic pylorus-preserving pancreaticoduodenectomy for pancreas head disease. Am J Surg 189:734–737

    Article  PubMed  Google Scholar 

  13. Ammori BJ (2004) Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience. Surg Endosc 18:717–718

    Article  CAS  PubMed  Google Scholar 

  14. Cuschieri A (1988) Laparoscopy for pancreatic cancer: does it benefit the patient? Eur J Surg Oncol 14:41–44

    CAS  PubMed  Google Scholar 

  15. Rhodes M, Nathanson L, Fielding G (1995) Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut 36:778–780

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Dulucq JL, Wintringer P, Mahajna A (2006) Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20:1045–1050

    Article  CAS  PubMed  Google Scholar 

  17. Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137

    Article  PubMed  Google Scholar 

  18. Kuroki T, Adachi T, Okamoto T, Kanematsu T (2012) A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepatogastroenterology 59:570–573

    Article  PubMed  Google Scholar 

  19. Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Oncologic advantages over open approaches? Ann Surg 260:633–640

    Article  PubMed  Google Scholar 

  20. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25

    Article  PubMed  Google Scholar 

  21. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  22. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  24. American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Book  Google Scholar 

  25. Al-Taan OS, Stephenson JA, Briggs C, Pollard C, Metcalfe MS, Dennison AR (2010) Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford) 12:239–243

    Article  Google Scholar 

  26. Gumbs AA, Gayet B (2008) The laparoscopic duodenopancreatectomy: the posterior approach. Surg Endosc 22:539–540

    Article  PubMed  Google Scholar 

  27. Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, Praveen Raj P (2009) Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 16:731–740

    Article  CAS  PubMed  Google Scholar 

  28. Kendrick ML, Cusati D (2010) Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 145:19–23

    Article  PubMed  Google Scholar 

  29. Zureikat AH, Breaux JA, Steel JL, Hughes SJ (2011) Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg 15:1151–1157

    Article  PubMed  Google Scholar 

  30. Bao PQ, Mazirka PO, Watkins KT (2014) Retrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg 18:682–689

    Article  PubMed  Google Scholar 

  31. Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196

    Article  CAS  PubMed  Google Scholar 

  32. Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S, Hyslop T, Schmidt CM, Rosato EL, Lavu H, Nakeeb A, Pitt HA, Lillemoe KD, Yeo CJ (2009) Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg 208:738–747; discussion 747–739

  33. Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, Salvia R, Pederzoli P (2003) Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 134:766–771

    Article  PubMed  Google Scholar 

  34. Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL (2000) Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg 231:293–300

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Balcom JHT, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136:391–398

    Article  PubMed  Google Scholar 

  36. Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, Terpstra OT, Zijlstra JA, Klinkert P, Jeekel H (2004) Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240:738–745

    Article  PubMed Central  PubMed  Google Scholar 

  37. Horstmann O, Markus PM, Ghadimi MB, Becker H (2004) Pylorus preservation has no impact on delayed gastric emptying after pancreatic head resection. Pancreas 28:69–74

    Article  PubMed  Google Scholar 

  38. Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion severity grading system. J Am Coll Surg 215:810–819

    Article  PubMed  Google Scholar 

  39. Boggi U, Amorese G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Mosca F (2015) Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc 29:9–23

    Article  PubMed  Google Scholar 

  40. Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy—a comparative study. Int J Surg 10:475–479

    Article  PubMed  Google Scholar 

  41. Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402

    Article  CAS  PubMed  Google Scholar 

  42. Valsangkar NP, Bush DM, Michaelson JS, Ferrone CR, Wargo JA, Lillemoe KD, Fernandez-del Castillo C, Warshaw AL, Thayer SP (2013) N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg 17:257–266

    Article  PubMed Central  PubMed  Google Scholar 

  43. Huebner M, Kendrick M, Reid-Lombardo KM, Que F, Therneau T, Qin R, Donohue J, Nagorney D, Farnell M, Sarr M (2012) Number of lymph nodes evaluated: prognostic value in pancreatic adenocarcinoma. J Gastrointest Surg 16:920–926

    Article  PubMed  Google Scholar 

  44. Hakeem AR, Verbeke CS, Cairns A, Aldouri A, Smith AM, Menon KV (2014) A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using leeds pathology protocol. Hepatobiliary Pancreat Dis Int 13:435–441

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by the West China Hospital, Sichuan University.

Disclosures

Mingjun Wang, Hua Zhang, Zhong Wu, Zhaoda Zhang, and Bing Peng have no competing financial interests.

Author information

Authors and Affiliations

  1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Mingjun Wang, Hua Zhang, Zhong Wu, Zhaoda Zhang & Bing Peng

Authors
  1. Mingjun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhaoda Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bing Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bing Peng.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, M., Zhang, H., Wu, Z. et al. Laparoscopic pancreaticoduodenectomy: single-surgeon experience. Surg Endosc 29, 3783–3794 (2015). https://doi.org/10.1007/s00464-015-4154-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4154-5

Keywords

Search

Navigation