Indian Journal of Surgical Oncology

, Volume 6, Issue 1, pp 20–25 | Cite as

Comparison of Pathological Radicality between Open and Laparoscopic Pancreaticoduodenectomy in a Tertiary Centre

  • Palanisamy Senthilnathan
  • Palanivelu Chinnusamy
  • Alwar Ramanujam
  • Srivatsan Gurumurthy Sivakumar
  • Anand Vijai Natesan
  • C. Chandramaliteeswaran
  • Praveen Raj Palanivelu
  • Parthasarathi Ramakrishnan
  • Rajapandian Subbiah
Original Article
First Online:
Received:
Accepted:

Abstract

Laparoscopic pancreaticoduodenectomy (LPD) remained a formidable challenge owing to retroperitoneal location, difficult dissection near great vessels and critical intracorporeal anastomoses. Recent reviews of literature have established the feasibility and comparable short term outcomes of laparoscopic pancreaticoduodenectomy (LPD) with that of open pancreaticoduodenectomy (OPD). This study was undertaken to compare the pathological radicality of LPD with OPD. A prospective database of all patients who underwent standard pancreaticoduodenectomy from Mar 2006 to Feb 2011 was taken up for this study. 45 patients who underwent LPD and 118 patients who underwent OPD for periampullary and pancreatic head malignancy were taken up for analysis. The study groups were comparable in terms of age of presentation, ASA grades, comorbidity, type of surgery and BMI. There was no statistically significant difference with regard to tumor size, lymph node yield, node positivity rates, R1 rates and margin lengths. The pathological radicality of laparoscopic pancreaticoduodenectomy is comparable with that of open approach when performed by experienced minimal-access surgeons. Standardized protocols for evaluation of the resection margins should be mandatory in studies reporting outcomes of pancreaticoduodectomy.

Keywords

Adenocarcinoma Pancreatic neoplasia Resection Pancreatic neoplasia Outcomes Pancreatic neoplasia Peri-ampullary tumours Pancreatic neoplasia 
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Supplementary material

13193_2014_372_MOESM1_ESM.doc (30 kb)
ESM 1 (DOC 29 kb)

References

  1. 1.
    Kooby DA, Chu CK (2010) Laparoscopic management of pancreatic malignancies. Surg Clin N Am 90(2):427–446CrossRefPubMedGoogle Scholar
  2. 2.
    Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8(5):408–410CrossRefPubMedGoogle Scholar
  3. 3.
    Cuschieri A (1994) Laparoscopic surgery of the pancreas. J R Coll Surg Edinb 39(3):178–184PubMedGoogle Scholar
  4. 4.
    Palanivelu C et al (2007) Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg 205(2):222–230CrossRefPubMedGoogle Scholar
  5. 5.
    Palanivelu C et al (2009) Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 16(6):731–740CrossRefPubMedGoogle Scholar
  6. 6.
    Gagner M, Palermo M (2009) Laparoscopic whipple procedure: review of the literature. J Hepatobiliary Pancreat Surg 16(6):726–730CrossRefPubMedGoogle Scholar
  7. 7.
    Gumbs AA et al (2011) Laparoscopic pancreatoduodenectomy: a review of 285 published cases. Ann Surg Oncol 18(5):1335–1341CrossRefPubMedGoogle Scholar
  8. 8.
    Correa-Gallego C et al (2014) Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 218(1):129–139CrossRefPubMedGoogle Scholar
  9. 9.
    Pedrazzoli S et al (1999) A surgical and pathological based classification of resective treatment of pancreatic cancer. Summary of an international workshop on surgical procedures in pancreatic cancer. Dig Surg 16(4):337–345CrossRefPubMedGoogle Scholar
  10. 10.
    Compton CC, Henson DE (1997) Protocol for the examination of specimens removed from patients with carcinoma of the exocrine pancreas: a basis for checklists. Cancer Committee, College of American Pathologists. Arch Pathol Lab Med 121(11):1129–1136PubMedGoogle Scholar
  11. 11.
    Yeo CJ et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236(3):355–366CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Farnell MB et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138(4):618–628CrossRefPubMedGoogle Scholar
  13. 13.
    Pedrazzoli S et al (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy study group. Ann Surg 228(4):508–517CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Menon KV et al (2009) Impact of margin status on survival following pancreatoduodenectomy for cancer: the leeds pathology protocol (LEEPP). HPB 11(1):18–24CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Butturini G et al (2008) Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg 143(1):75–83CrossRefPubMedGoogle Scholar
  16. 16.
    Rowsell C et al (2007) Improved lymph node retrieval in Whipple specimens as a result of implementation of a new uncinate margin protocol. HPB 9(5):388–391CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Raut CP et al (2007) Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 246(1):52–60CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2015

Authors and Affiliations

  • Palanisamy Senthilnathan
    • 1
  • Palanivelu Chinnusamy
    • 1
  • Alwar Ramanujam
    • 1
  • Srivatsan Gurumurthy Sivakumar
    • 1
  • Anand Vijai Natesan
    • 1
  • C. Chandramaliteeswaran
    • 1
  • Praveen Raj Palanivelu
    • 1
  • Parthasarathi Ramakrishnan
    • 1
  • Rajapandian Subbiah
    • 1
  1. 1.Gem Hospital and Research CentreMinimal Access and HPB Surgery CoimbatoreTamil NaduIndia

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