title: Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?
abstract: OBJECTIVE
  To directly compare the oncologic outcomes of TLPD and OPD in the setting of pancreatic ductal adenocarcinoma.
  
  
  BACKGROUND
  Total laparoscopic pancreaticoduodenectomy (TLPD) has been demonstrated to be feasible and may have several potential advantages over open pancreaticoduodenectomy (OPD), including lower blood loss and shorter hospital stay. Whether potential advantages could allow patients to recover in a timelier manner and pursue adjuvant treatment options remains to be answered.
  
  
  METHODS
  We reviewed data for all patients undergoing TLPD (N = 108) or OPD (N = 214) for pancreatic ductal adenocarcinoma at our institution between January 2008 and July 2013.
  
  
  RESULTS
  Neoadjuvant therapy, tumor size, node positivity, and margin-positive resection were not significantly different between the 2 groups. Median length of hospital stay was significantly longer in the OPD group (9 days; range, 5-73 days) than in the TLPD group (6 days; range, 4-118 days; P < 0.001). There was a significantly higher proportion of patients in the OPD group (12%) who had a delay of greater than 90 days or who did not receive adjuvant chemotherapy at all compared with that in the TLPD group (5%; P = 0.04). There was no significant difference in overall survival between the 2 groups (P = 0.22). A significantly longer progression-free survival was seen in the TLPD group than in the OPD group (P = 0.03).
  
  
  CONCLUSIONS
  TLPD is not only feasible in the setting of pancreatic ductal adenocarcinoma but also has advantages such as shorter hospital stay and faster recovery, allowing patients to recover in a timelier manner and pursue adjuvant treatment options. This study also demonstrated a longer progression-free survival in patients undergoing TLPD than those undergoing OPD.
authors.affiliation: From the Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Croome
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
authors.forename: K Marie
authors.initials: KM
authors.lastname: Reid-Lombardo
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Truty
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors