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Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution

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Abstract

Background

Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period.

Methods

From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed.

Results

Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively.

Conclusion

LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.

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Acknowledgments

The authors would like to acknowledge Mauricia Buchanan for her assistance in collecting data for the purpose of this study and the Mayo Clinic in Florida Division of Biomedical Statistics and Informatics for the statistical analysis.

Funding

Funding for statistical support provided by the Cancer Focused Research team at Mayo Clinic in Jacksonville, Florida.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA

    John A. Stauffer, Diego Villacreses & Horacio J. Asbun

  2. Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Alessandro Coppola

  3. Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA

    Kabir Mody & Elizabeth Johnson

  4. Department of Biomedical Statistics and Informatics, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA

    Zhuo Li

Authors
  1. John A. Stauffer
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  2. Alessandro Coppola
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  3. Diego Villacreses
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  4. Kabir Mody
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  5. Elizabeth Johnson
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  6. Zhuo Li
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  7. Horacio J. Asbun
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Corresponding author

Correspondence to John A. Stauffer.

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Disclosures

Drs. Stauffer, Coppola, Villacreses, Johnson, Mody, and Asbun and Mrs. Li have no conflicts of interest or financial ties to disclose in relation to this manuscript.

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Stauffer, J.A., Coppola, A., Villacreses, D. et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc 31, 2233–2241 (2017). https://doi.org/10.1007/s00464-016-5222-1

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  • DOI: https://doi.org/10.1007/s00464-016-5222-1

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