Abstract
Purpose
We compared the outcome of hybrid laparoscopic pylorus-preserving pancreatoduodenectomy (lapPPPD) and open PPPD (oPPPD) in a retrospective case-matched study.
Methods
Patients operated from 2010 to 2013 by lapPPPD were matched 1:1 for age, sex, histopathology, American Society of Anesthesiologists category and body mass index to oPPPD patients operated from 1996 to 2013.
Results
Patients eligible for lapPPPD are a risk group due to a high rate of soft pancreata. Complication rate and mortality were comparable to oPPPD. There was a significantly reduced transfusion requirement and a trend towards shorter operation time, less delayed gastric emptying, and reduced hospital stay. The main reason for conversion was portal venous tumor adhesion. Patient selection changed and operation time and hospital stay decreased with the surgeons’ experience.
Conclusion
In selected patients, a hybrid laparoscopic technique of pancreatoduodenectomy is feasible with complication rates comparable to the open procedure. There seem to be advantages in terms of transfusion requirement, operation time, and hospital stay.
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References
Venkat R, Edil BH, Schulick RD et al (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255:1048–1059. doi:10.1097/SLA.0b013e318251ee09
Zhang J, Wu W-M, You L, Zhao Y-P (2013) Robotic versus open pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 20:1774–1780. doi:10.1245/s10434-012-2823-3
Nigri G, Petrucciani N, La Torre M et al (2014) Duodenopancreatectomy: open or minimally invasive approach? Surg J R Coll Surg Edinb Irel. doi:10.1016/j.surge.2014.01.006
Correa-Gallego C, Dinkelspiel HE, Sulimanoff I et al (2014) Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 218:129–139. doi:10.1016/j.jamcollsurg.2013.09.005
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. doi:10.1016/j.jamcollsurg.2012.08.006
Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc 27:4518–4523. doi:10.1007/s00464-013-3101-6
Cho A, Yamamoto H, Nagata M et al (2009) Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 198:445–9
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. doi:10.5754/hge11351
Keck T, Kuesters S, Wellner U, et al. (2010) Laparoscopic pylorus-preserving pancreatic head resection and hybrid open reconstruction via pancreatogastrostomy. J Gastrointest Surg in press:
Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumors of the digestive system, 4th edn. International Agency for Research in Cancer, Lyon
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. doi:10.1097/01.sla.0000133083.54934.ae
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25. doi:10.1016/j.surg.2007.02.001
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–8
Belyaev O, Herden H, Meier JJ, et al. (2008) Assessment of pancreatic hardness-surgeon versus durometer. J Surg Res
Murakami Y, Uemura K, Hayasidani Y et al (2008) A soft pancreatic remnant is associated with increased drain fluid pancreatic amylase and serum CRP levels following pancreatoduodenectomy. J Gastrointest Surg 12:51–6
Wellner UF, Kayser G, Lapshyn H et al (2010) A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB 12:696–702. doi:10.1111/j.1477-2574.2010.00239.x
Wellner UF, Sick O, Olschewski M et al (2012) Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract 16:1686–1695. doi:10.1007/s11605-012-1940-4
Esposito I, Kleeff J, Bergmann F et al (2008) Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 15:1651–1660. doi:10.1245/s10434-008-9839-8
Menon KV, Gomez D, Smith AM et al (2009) Impact of margin status on survival following pancreatoduodenectomy for cancer: the leeds pathology protocol (LEEPP). HPB 11:18–24
Authors’ contributions
TK, UFW, and SK contributed to the study conception and design; TK, KWK, SK, DB, and UFW for the operations; PB for the histopathological assessment; and OS, CB, and PB for the data acquisition. UFW, CB, and SK analyzed and interpreted the data. UFW, CB, and SK drafted the manuscript. Critical revision of the manuscript was done by TK, UTH, DB, and KWK.
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Ulrich Friedrich Wellner and Simon Küsters contributed equally to this work.
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Wellner, U.F., Küsters, S., Sick, O. et al. Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbecks Arch Surg 399, 849–856 (2014). https://doi.org/10.1007/s00423-014-1236-0
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DOI: https://doi.org/10.1007/s00423-014-1236-0