title: Matched Case-Control Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy for Malignant Lesions.
abstract: BACKGROUND
  Advances in surgical technologies allowed safe laparoscopic pancreaticoduodenectomy (LPD). The aim of this study is to compare the oncologic outcomes of LPD to open pancreaticoduodenectomy (OPD) in terms of safety and recurrence rate.
  
  
  METHODS
  A cohort of 30 patients were matched for age, sex, American Society of Anaesthesiologists, tumor size, pancreatic duct diameter, and histopathologic diagnosis on a 1:1 basis (15 LPD, 15 OPD). Comparison between groups was performed on intention-to-treat basis. Survival following resection was compared using the Kaplan-Meier survival analysis.
  
  
  RESULTS
  The median operating time for LPD group was longer than for OPD group (470 vs. 310 min; P=0.184). However, estimated blood loss (300 vs. 620 mL; P=0.023), high dependency unit stay (2.0 vs. 6.0 d; P=0.013) and postoperative hospital stay (9.0 vs. 17.4 d; P=0.017) were significantly lower in the LPD group. There was no significant difference in postoperative rates of morbidity (40% vs. 67%; P=0.431) and mortality (0% vs. 6.7%; P=0.99). The surgical resection margins R0 status (87% vs. 73%; P=0.79) and the number of lymph nodes (18 vs. 20; P=0.99) in the resected specimens were comparable between the 2 groups. There was no significant difference in overall survival outcomes.
  
  
  CONCLUSIONS
  In selected patients, the laparoscopic approach to pancreaticoduodenectomy in the hands of the experienced offers advantages over open surgery without compromising the oncologic resection.
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.|Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
authors.forename: Yazan S
authors.initials: YS
authors.lastname: Khaled
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.
authors.forename: Kavi
authors.initials: K
authors.lastname: Fatania
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Barrie
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Liguori
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.
authors.forename: Rahul
authors.initials: R
authors.lastname: Deshpande
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.|Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
authors.forename: Derek A
authors.initials: DA
authors.lastname: O'Reilly
authors.affiliation: The Hepato-Pancreato-Biliary Unit, North Manchester General Hospital.|Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom