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Oncologic and Perioperative Outcomes Following Selective Application of Laparoscopic Pancreaticoduodenectomy for Periampullary Malignancies

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Data are sparse regarding patient selection criteria or evaluating oncologic outcomes following laparoscopic pancreaticoduodenectomy (LPD). Having prospectively limited LPD to patients with resectable disease defined by National Comprehensive Cancer Network (NCCN) criteria, we evaluated perioperative and long-term oncologic outcomes of LPD compared to a similar cohort of open pancreaticoduodenectomy (OPD).

Methods

Consecutive patients (November 2010–February 2014) undergoing pancreaticoduodenectomy (PD) for periampullary adenocarcinoma were reviewed. Patients were excluded from further analysis for benign pathology, conversion to OPD for portal vein resection, and contraindications for LPD not related to their malignancy. Outcomes of patients undergoing LPD were analyzed in an intention-to-treat manner against a cohort of patients undergoing OPD.

Results

These selection criteria resulted in offering LPD to 77 % of all cancer patients. Compared to the OPD cohort, LPD was associated with significant reductions in wound infections (16 vs. 34 %; P = 0.038), pancreatic fistula (17 vs. 36 %; P = 0.032), and median hospital stay (9 vs. 12 days; P = 0.025). Overall survival (OS) was not statistically different between patients undergoing LPD vs. OPD for periampullary adenocarcinoma (median OS 27.9 vs. 23.5 months; P = 0.955) or pancreatic adenocarcinoma (N = 28 vs. 22 patients; median OS 20.7 vs. 21.1 months; P = 0.703).

Conclusions

The selective application of LPD for periampullary malignancies results in a high degree of eligibility as well as significant reductions in length of stay, wound infections, and pancreatic fistula. Overall survival after LPD is similar to OPD.

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Acknowledgments

This study was supported in part by training grant NCI 5T32CA106493-09 (D.D.), funds from the Cracchiolo Foundation (D.D.), and the Frederick A. Coller Surgical Society (D.D.).

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, University of Florida Health Science Center, Gainesville, FL, 32610, USA

    Daniel Delitto, Casey M. Luckhurst, Brian S. Black, George A. Sarosi, Ryan M. Thomas, Jose G. Trevino, Kevin E. Behrns & Steven J. Hughes

  2. Department of Radiology, College of Medicine, University of Florida Health Science Center, Gainesville, FL, 32610, USA

    John L. Beck

  3. Department of Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, FL, 32610, USA

    Thomas J. George Jr.

  4. Department of Surgery, North Florida South Georgia Veterans Health System, Gainesville, FL, 32610, USA

    George A. Sarosi & Ryan M. Thomas

Authors
  1. Daniel Delitto
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  2. Casey M. Luckhurst
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  3. Brian S. Black
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  7. Ryan M. Thomas
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  9. Kevin E. Behrns
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  10. Steven J. Hughes
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Correspondence to Steven J. Hughes.

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Delitto, D., Luckhurst, C.M., Black, B.S. et al. Oncologic and Perioperative Outcomes Following Selective Application of Laparoscopic Pancreaticoduodenectomy for Periampullary Malignancies. J Gastrointest Surg 20, 1343–1349 (2016). https://doi.org/10.1007/s11605-016-3136-9

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  • DOI: https://doi.org/10.1007/s11605-016-3136-9

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