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Journal of Gastrointestinal Surgery

, Volume 19, Issue 1, pp 189–194 | Cite as

Pancreaticoduodenectomy with Major Vascular Resection: a Comparison of Laparoscopic Versus Open Approaches

  • Kris P. Croome
  • Michael B. Farnell
  • Florencia G. Que
  • KMarie Reid-Lombardo
  • Mark J. Truty
  • David M. Nagorney
  • Michael L. Kendrick
2014 SSAT Plenary Presentation

Abstract

Background

Major vascular resection when necessary for margin control during pancreaticoduodenectomy is relatively universal with perioperative and oncological outcomes that are similar to those of patients undergoing a PD without venous involvement. The present study compares total laparoscopic pancreaticoduodenectomy (TLPD) versus open pancreaticoduodenectomy (OPD) with major vascular resection.

Methods

We reviewed data for all patients undergoing TLPD or OPD with vascular resection at Mayo Clinic Rochester, between the dates of July 2007 and July 2013.

Results

A total of 31 patients undergoing TLPD and 58 patients undergoing OPD with major vascular resection were identified. Mean operative blood loss was significantly less in the laparoscopic (842 cc) compared to the open group (1,452 cc) (p < 0.001), as was median hospital stay, 6 (4–118) versus 9 (6–73) days, respectively (p = 0.006). There was no significant difference in the total number of complications (lap 35 %, open 48 %) (p = 0.24) or severe complications (≥III) (lap 6.4 %, open 3.4 %) (p = 0.51) in the two groups. In-hospital mortality or 30-day mortality was not statistically different between the laparoscopic and open groups, 3.2 and 3.4 %, respectively (p = 0.96). Patency of the reconstructed vessels on postoperative imaging was not significantly different between the TLPD (93 %) and OPD groups (91 %) (p = 0.76). In patients with a diagnosis of adenocarcinoma, there was no significant difference in overall survival between the two groups (p = 0.22).

Conclusion

The present study clearly demonstrates that not only is TLPD with major vascular resection feasible and safe but that it can achieve results that are similar in morbidity and mortality as well as oncologic outcome compared to patients undergoing OPD with major vascular resection.

Keywords

Laparoscopic Whipple Venous Pancreaticoduodenectomy Minimally invasive 

Abbreviations

TLPD

Total laparoscopic pancreaticoduodenectomy

OPD

Open pancreaticoduodenectomy

PD

Pancreaticoduodenectomy

CI

Confidence interval

CT

Computed tomography

SD

Standard deviation

PV

Portal vein

SMV

Superior mesenteric vein

Notes

Conflict of Interest

None of the authors have any conflict of interest to disclose. The manuscript did not receive any funding.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Kris P. Croome
    • 1
  • Michael B. Farnell
    • 1
  • Florencia G. Que
    • 1
  • KMarie Reid-Lombardo
    • 1
  • Mark J. Truty
    • 1
  • David M. Nagorney
    • 1
  • Michael L. Kendrick
    • 1
    • 2
  1. 1.Division of Subspecialty General SurgeryMayo ClinicRochesterUSA
  2. 2.Department of SurgeryMayo ClinicRochesterUSA

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