title: Matched Case-Control Analysis Comparing Laparoscopic and Open Pylorus-preserving Pancreaticoduodenectomy in Patients With Periampullary Tumors.
abstract: OBJECTIVE
  To evaluate the safety, feasibility, and oncologic outcomes of laparoscopic pylorus-preserving pancreaticoduodenectomy (L-PPPD) to treat periampullary tumors. The clinical outcomes of L-PPPD were compared with open pylorus-preserving pancreaticoduodenectomy (O-PPPD).
  
  
  BACKGROUND
  Despite recent advances in laparoscopic pancreatic surgery, few studies have compared L-PPPD with O-PPPD. The safety, short-term clinical benefits, and oncologic outcomes of L-PPPD remain controversial.
  
  
  METHODS
  Between January 2007 and December 2012, a total of 2192 patients diagnosed with periampullary tumors were treated with curative resection at our institution. Of these patients, 137 underwent a laparoscopic approach and 2055 an open technique. A retrospective study was performed to evaluate the safety, feasibility, and oncologic outcomes of L-PPPD compared with O-PPPD.
  
  
  RESULTS
  The mean operation time for the L-PPPD group was longer than for the O-PPPD group (P < 0.001). Estimated blood loss was similar, as was the incidence of complications, such as pancreatic fistula and delayed gastric empting (P > 0.05). The mean number of analgesic injections administered was lower in the L-PPPD group than in the O-PPPD group (P < 0.001), and the mean duration of the postoperative hospital stays was shorter (P < 0.001). The surgical resection margins and the number of lymph nodes in the resected specimens did not differ between the 2 groups, and there was no significant difference in overall survival curves.
  
  
  CONCLUSIONS
  L-PPPD had the typical advantages of minimally invasive abdominal procedures, such as less pain, shorter hospital stay, and quicker recovery. It is technically safe and feasible, and has favorable oncologic outcomes in comparison with O-PPPD in patients with periampullary tumors.
authors.affiliation: From the Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Ulsan University College of Medicine and Asan Medical Center, Seoul, South Korea.
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.forename: Song Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Dae Wook
authors.initials: DW
authors.lastname: Hwang
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Lee
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Kwang-Min
authors.initials: KM
authors.lastname: Park
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D014670:Ampulla of Vater; D016022:Case-Control Studies; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome