Laparoscopic pancreaticoduodenectomy: single-surgeon experience

Innovations in surgical strategies and technologies have facilitated laparoscopic pancreaticoduodenectomy (LPD). However, data regarding the short-term and long-term results of LPD are sparse, and this procedure is the primary focus of the current study.

Between October 2010 and October 2013, a total of 31 consecutive patients received LPD, including hand-assisted laparoscopic pancreaticoduodenectomy, total laparoscopic pancreaticoduodenectomy, and laparoscopic pylorus-preserving pancreaticoduodenectomy. Data regarding short-term surgical outcomes and long-term oncological results were collected prospectively.

The median operative time was 515.0 min (interquartile range 465.0–585.0 min). The median intraoperative estimated blood loss was 260.0 mL (interquartile range 150.0–430.0 mL). Conversion to open pancreaticoduodenectomy was required in three patients (9.7 %) due to intraoperative pneumoperitoneum intolerance (n = 1, 3.2 %) and tumor adherence to the superior mesenteric vein (n = 2, 6.5 %). No significant differences between the surgical approaches were observed in regard to intraoperative and postoperative data. Postoperative severe complications (Clavien ≥ III) were detected in three (9.7 %) patients, including one grade C pancreatic fistula, one grade B postoperative bleeding event, and one afferent loop obstruction. There were no deaths within 30 days following LPD. The final pathological results revealed duodenal adenocarcinoma in 14 (45.2 %) patients, ampullary adenocarcinoma in four (12.9 %) patients, distal common bile duct cancer in six (19.4 %) patients, pancreatic ductal adenocarcinoma in five (16.1 %) patients, gastrointestinal stroma tumor in one (3.2 %) patient, and chronic pancreatitis in one (3.2 %) patient. All patients suffering from tumors underwent R0 resection (n = 30, 100.0 %), with the optimal number of collected lymph nodes (median: 13, interquartile range 11–19). At the most recent follow-up, 20 patients were still alive, and the 1-, and 3-year overall survival for patients with duodenal adenocarcinoma were 100.0 and 71.4 %, respectively.

According to this study, LPD is feasible and technically safe for highly selected patients and can offer acceptable oncological outcomes and long-term survival.