A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

• Published in: Hepatobiliary & pancreatic diseases international Vol. 13; no. 4; pp. 435 - 441
• Main Authors: Hakeem, Abdul R, Verbeke, Caroline S, Cairns, Alison, Aldouri, Amer, Smith, Andrew M, Menon, Krishna V
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 15.08.2014
• Subjects: Aged; Common Bile Duct Neoplasms - mortality; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Humans; Kaplan-Meier Estimate; laparoscopic; Laparoscopy - adverse effects; Laparoscopy - mortality; Length of Stay; Lymphatic Metastasis; Male; Matched-Pair Analysis; Medicin och hälsovetenskap; Middle Aged; minimally invasive; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasm, Residual; oncological outcomes; open; pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; pathology; Postoperative Complications - etiology; resection margins; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Tumor Burden; oncological outcomes; pathology; pancreaticoduodenectomy; resection margins; laparoscopic; minimally invasive; open
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(14)60048-5

Background Laparoscopic pancreaticoduodenectomy (LPD) is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes, in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy (OPD). Methods Between November 2005 and April 2009, 12 LPDs (9 ampullary and 3 distal common bile duct tumors) were performed. A cohort of 12 OPDs were matched for age, gender, body mass index (BMI) and American Society of Anesthesiologists (ASA) score and tumor site. Results Mean tumor size LPD vs OPD (19.8 vs 19.2 mm, P =0.870). R0 resection was achieved in 9 LPD vs 8 OPD ( P =1.000). The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1 ( P =0.140) and 20.7 vs 18.5 ( P =0.534) respectively. Clavien complications grade I/II (5 vs 8), III/IV (2 vs 6) and pancreatic leak (2 vs 1) were statistically not significant (LPD vs OPD). The mean high dependency unit (HDU) stay was longer in OPD (3.7 vs 1.4 days, P <0.001). There were 2 recurrences each in LPD and OPD (log-rank, P =0.983). Overall mortality for LPD vs OPD was 3 vs 6 (log-rank, P =0.283) and recurrence-related mortality was 2 vs 1. There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group. Conclusions Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and long-term recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.