title: Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience.
abstract: BACKGROUND
  Few reports describe the use of laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) in centers with experience using this technique. In addition, the clinical outcomes of this procedure remain undetermined.
  
  
  METHODS
  In the current study, 100 patients with benign or malignant lesions in the pancreatic head underwent LPPPD between May 2007 and December 2011. The overall clinical outcomes and changes in these outcomes during the surgeon learning period were analyzed to assess the feasibility and safety of this procedure.
  
  
  RESULTS
  Pathologic examination of the pancreas confirmed intraductal papillary mucinous neoplasms in 37 patients, solid pseudopapillary tumors in 17 patients, neuroendocrine tumors in 15 patients, serous cystic neoplasms in seven patients, pancreatic ductal adenocarcinomas in seven patients, ampulla of Vater tumors and duodenal gastrointestinal stromal tumors in five patients, and other disease in seven patients. The median operative time was 7.9 h, which decreased with accumulating experience of the surgeon using this procedure, from 9.8 h for the first 33 cases to 6.6 h for the last 34 cases. Complications developed in 25% of the patients, including six cases (6%) with significant pancreatic fistula [International Study Group on Pancreatic Fistula (ISGPF) grade B]. The complication rate decreased from 33.3% for the first 33 cases to 17.6% for the last 34 cases. The mean hospital stay was 14 days, which also decreased from 20.4 days for the first 33 cases to 11.5 days for the last 34 cases. For the 12 patients in the study cohort with invasive malignant disease, the median tumor size was 2.8 cm, and the median number of lymph nodes harvested was 13. All the patients had margin-negative R0 resections.
  
  
  CONCLUSIONS
  The LPPPD procedure is technically safe and feasible, with an acceptable rate of morbidity and other clinical outcomes for benign and malignant diseases. Clinical outcomes can be improved once a learning curve has been overcome.
authors: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. drksc@amc.seoul.kr
authors: Song C
authors: SC
authors: Kim
authors: Ki B
authors: KB
authors: Song
authors: Yong S
authors: YS
authors: Jung
authors: Young H
authors: YH
authors: Kim
authors: Do H
authors: DH
authors: Park
authors: Sang S
authors: SS
authors: Lee
authors: Dong W
authors: DW
authors: Seo
authors: Sung K
authors: SK
authors: Lee
authors: Myung H
authors: MH
authors: Kim
authors: Kwang M
authors: KM
authors: Park
authors: Young J
authors: YJ
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002983:Clinical Competence / Q000592:standards; D004379:Duodenal Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000592:standards; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult