Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution.
Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period.



From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed.



Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively.



LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.
Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA. stauffer.john@mayo.edu.
John A
JA
Stauffer
Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
Alessandro
A
Coppola
Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Diego
D
Villacreses
Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Kabir
K
Mody
Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Elizabeth
E
Johnson
Department of Biomedical Statistics and Informatics, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Zhuo
Z
Li
Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Horacio J
HJ
Asbun
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
Laparoscopic pancreaticoduodenectomy; Laparoscopy; Pancreatic adenocarcinoma