Abstract
Background
The purpose of this study is to present the largest reported series comparing open pancreaticoduodenectomy (OPD) to total laparoscopic pancreaticoduodenectomy (TLPD) in patients with ampullary neoplasms.
Methods
Patients undergoing OPD or TLPD for ampullary neoplasms from June 2012 to August 2016 were retrospectively identified. Perioperative outcomes were compared using a Wilcoxon rank-sum test, Student’s t test, and Chi square analysis where appropriate. Kaplan–Meier estimates for progression-free survival (PFS) and overall survival (OS) were compared between the groups using the log-rank test.
Results
We identified 47 patients with ampullary neoplasms (adenocarcinoma n = 36, neuroendocrine tumor n = 7, undifferentiated n = 1, adenoma n = 3) undergoing OPD (n = 25) and TLPD (n = 22). The proportion of patients being offered TLPD has progressively increased every year over 5 years: 0% (2012) to 50% (2015). There were no differences in baseline variables between the two groups. TLPD was associated with less blood loss (300 vs. 500 mL, p < 0.001) and shorter operative times (314 vs. 359 min, p = 0.024). No patient required conversion to an open procedure and there were no perioperative deaths in either group. TLPD was associated with lower rates of intra-abdominal abscess (0 vs. 16.0%, p = 0.049), but there were no differences in rates of pancreatic fistula, bile leak, delayed gastric emptying, wound infection, length of stay, and readmission (all p > 0.05). Among patients with adenocarcinoma, there was no difference in pathological features between the two groups (p > 0.05) and all patients had negative margins. At a median follow up of 25 months, there was no difference in PFS or OS between the two groups.
Conclusions
TLPD in patients with ampullary neoplasms results in improved perioperative outcomes while having equivalent short and long-term oncologic outcomes compared to the traditional open approach.
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References
Kimura W, Futakawa N, Zhao B (2004) Neoplastic diseases of the papilla of Vater. J Hepatobiliary Pancreat Surg 11:223–231
Rostain F, Hamza S, Drouillard A, Faivre J, Bouvier AM, Lepage C (2014) Trends in incidence and management of cancer of the ampulla of Vater. World J Gastroenterol 7:10144–10150
Howe JR, Klimstra DS, Moccia RD, Conlon KC, Brennan MF (1998) Factors predictive of survival in ampullary carcinoma. Ann Surg 228:87–94
Benhamiche AM, Jouve JL, Manfredi S, Prost P, Isambert N, Faivre J (2000) Cancer of the ampulla of Vater: results of a 20-year population-based study. Eur J Gastroenterol Hepatol 12:75–79
Albores-Saavedra J, Schwartz AM, Batich K, Henson DE (2009) Cancers of the ampulla of vater: demographics, morphology, and survival based on 5,625 cases from the SEER program. J Surg Oncol 100:598–605
Kimura W, Futakawa N, Yamagata S, Wada Y, Kuroda A, Muto T, Esaki Y (1994) Different clinicopathologic findings in two histologic types of carcinoma of papilla of Vater. Jpn J Cancer Res 85:161–166
Carter JT, Grenert JP, Rubenstein L, Stewart L, Way LW (2008) Tumors of the ampulla of Vater: histopathologic classification and predictors of survival. J Am Coll Surg 207:210–218
Fischer HP, Zhou H (2004) Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg 11:301–309
Sommerville CA, Limongelli P, Pai M, Ahmad R, Stamp G, Habib NA, Williamson RC, Jiao LR (2009) Survival analysis after pancreatic resection for ampullary and pancreatic head carcinoma: an analysis of clinicopathological factors. J Surg Oncol 100:651–656
Bettschart V, Rahman MQ, Engelken FJ, Madhavan KK, Parks RW, Garden OJ (2004) Presentation, treatment and outcome in patients with ampullary tumours. Br J Surg 91:1600–1607
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
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
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 161:584–591
Kim RD, Kundhal PS, McGilvray ID, Cattral MS, Taylor B, Langer B, Grant DR, Zogopoulos G, Shah SA, Greig PD, Gallinger S (2006) Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg 202:112–119
Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL (1997) Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 225:590–599
Qiao QL, Zhao YG, Ye ML, Yang YM, Zhao JX, Huang YT, Wan YL (2007) Carcinoma of the ampulla of Vater: factors influencing long-term survival of 127 patients with resection. World J Surg 31:137–143
de Rooij T, Lu MZ, Steen MW, Gerhards MF, Dijkgraaf MG, Busch OR, Lips DJ, Festen S, Besselink MG (2016) Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg 264:257–267
Paniccia A, Schulick RD, Edil BH (2015) Total laparoscopic pancreaticoduodenectomy: a single-institutional experience. Ann Surg Oncol 22:4380–4381
Stauffer JA, Coppola A, Villacreses D, Mody K, Johnson E, Li Z, Asbun HJ (2016) Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc 31:2233–2241
Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–638
de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, Porte RJ, Gouma DJ, Busch OR, Molenaar IQ (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99:404–410
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1210
Adam MA, Roman SA, Sosa JA (2015) Minimally invasive versus open pancreaticoduodenectomy for cancer is associated with increased 30-day mortality. Ann Surg 262:372–377
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Brandon C. Chapman, Ana Gleisner, Irada Ibrahim-Zada, Douglas M. Overbey, Alessandro Paniccia, Cheryl Meguid, Brian Brauer, Csaba Gajdos, Martin D McCarter, Richard D. Schulick, and Barish H. Edil have no conflicts of interest or financial ties to disclose.
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Chapman, B.C., Gleisner, A., Ibrahim-Zada, I. et al. Laparoscopic pancreaticoduodenectomy: changing the management of ampullary neoplasms. Surg Endosc 32, 915–922 (2018). https://doi.org/10.1007/s00464-017-5766-8
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DOI: https://doi.org/10.1007/s00464-017-5766-8