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Laparoscopic Pancreaticoduodenectomy: Outcomes and Experience of 550 Patients in a Single Institution

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic pancreaticoduodenectomy (LPD) is one of the most technically challenging surgical procedures, involving complicated dissection and reconstruction. Recently, enthusiasm for performing this procedure has increased; however, concerns have been raised regarding its perioperative and oncologic outcomes.

Methods

We retrospectively reviewed patients who underwent LPD between 2010 and 2019 at our institution. We analyzed perioperative and oncologic outcomes of LPD, risk factors associated with complications, and the learning curve.

Results

550 patients underwent LPD, including 473 standard LPD and 77 LPD with vascular resection. Of these, 38.5% experienced complications. Pancreatic fistula occurred in 24% of patients. Five patients died within 90 days. No significant differences were observed in terms of complications or 90-day mortality between patients who underwent LPD with vascular resection versus standard LPD. Patients with pancreatic cancer had the shortest median survival time (20 months); patients with duodenal or papillary cancer had the longest median survival time (50 months). Pancreatic cancer, American Society of Anesthesiologists (ASA) score, and operative time were risk factors associated with complications, and previous abdominal surgery, ASA score, and body mass index were risk factors associated with severe complications. Finally, surgeons who performed standard LPD had a learning period of 47 procedures, whereas surgeons who performed LPD with vascular resection were proficient after having performed 200 standard LPD procedures.

Conclusions

LPD is a safe, feasible, and oncologically acceptable procedure when performed in a high-volume center. Performance of LPD should follow a step-by-step principle because of the long and steep learning curve.

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Abbreviations

BMI:

Body mass index

DGE:

Delayed gastric emptying

LPD:

Laparoscopic pancreaticoduodenectomy

OPD:

Open pancreaticoduodenectomy

OT:

Operative time

POPF:

Postoperative pancreatic fistula

PPH:

Postpancreatic hemorrhage

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Authors and Affiliations

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

    Xin Wang MD & Bing Peng MD, FACS

  2. Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China

    Yunqiang Cai MD & Bing Peng MD, FACS

  3. Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China

    Jingwen Jiang MS

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  1. Xin Wang MD
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  2. Yunqiang Cai MD
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  3. Jingwen Jiang MS
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  4. Bing Peng MD, FACS
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Correspondence to Bing Peng MD, FACS.

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Disclosure

This study was supported by the National Institutes of Health of China (W2017ZWS07) and Science and Technology Department of Sichuan Province (2018KZ0021).

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Wang, X., Cai, Y., Jiang, J. et al. Laparoscopic Pancreaticoduodenectomy: Outcomes and Experience of 550 Patients in a Single Institution. Ann Surg Oncol 27, 4562–4573 (2020). https://doi.org/10.1245/s10434-020-08533-3

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  • DOI: https://doi.org/10.1245/s10434-020-08533-3

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