title: Long-term results of laparoscopic pancreaticoduodenectomy for pancreatic and periampullary cancer-experience of 130 cases from a tertiary-care center in South India.
abstract: BACKGROUND
  Laparoscopic pancreaticoduodenectomy (LPD), although an advanced surgical procedure, is being increasingly used for pancreatic head and periampullary tumors. We present our experience of 15 years with the largest series in total LPD for periampullary and pancreatic head tumors with data on oncological outcome and long-term survival.
  
  
  METHODS
  Prospective and retrospective data of patients undergoing LPD from March 1998 to April 2013 were reviewed. Of the 150 cases, 20 cases of LPD (7 cases done for chronic pancreatitis and 13 cases for benign cystic tumors of the pancreas) have been excluded, which leaves us with 130 cases of LPD performed for malignant indications.
  
  
  RESULTS
  In total, 130 patients were chosen for the study. The male:female ratio was 1:1.6, with a median age of 54 years. We had one conversion to open surgery in our series, the overall postoperative morbidity was 29.7%, and the mortality rate was 1.53%. The pancreatic fistula rate was 8.46%. The mean operating time was 310±34 minutes, and the mean blood loss was 110±22 mL. The mean hospital stay was 8±2.6 days. Resected margins were positive in 9.23% of cases. The mean tumor size was 3.13±1.21 cm, and the mean number of retrieved lymph nodes was 18.15±4.73. The overall 5-year actuarial survival was 29.42%, and the median survival was 33 months.
  
  
  CONCLUSIONS
  LPD has evolved over a period of two decades and has the potential to become the standard of care for select periampullary and pancreatic head tumors with acceptable oncological outcomes, especially in high-volume centers. Randomized controlled trials are needed to establish the advantages of LPD.
authors: Minimal Access and HPB Surgery, Gem Hospital and Research Centre , Coimbatore, Tamil Nadu, India .
authors: Palanisamy
authors: P
authors: Senthilnathan
authors: Sivakumar
authors: S
authors: Srivatsan Gurumurthy
authors: Shiekh Imran
authors: SI
authors: Gul
authors: Sandeep
authors: S
authors: Sabnis
authors: Anand Vijai
authors: AV
authors: Natesan
authors: Nalankilli V
authors: NV
authors: Palanisamy
authors: P
authors: P
authors: Praveen Raj
authors: Rajapandian
authors: R
authors: Subbiah
authors: Parthasarathi
authors: P
authors: Ramakrishnan
authors: Chinnusamy
authors: C
authors: Palanivelu
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome