Safi Dokmak1, Fadhel Samir Ftériche2, Béatrice Aussilhou2, Philippe Lévy3, Philippe Ruszniewski3, Jérome Cros4, Marie Pierre Vullierme5, Linda Khoy Ear6, Jacques Belghiti2, Alain Sauvanet2. 1. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, APHP, University Paris VII, Clichy, France. Electronic address: safi.dokmak@aphp.fr. 2. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, APHP, University Paris VII, Clichy, France. 3. Department of Gastroenterology, Beaujon Hospital, APHP, University Paris VII, Clichy, France. 4. Department of Pathology, Beaujon Hospital, APHP, University Paris VII, Clichy, France. 5. Department of Radiology, Beaujon Hospital, APHP, University Paris VII, Clichy, France. 6. Department of Anesthesia and Intensive Care, Beaujon Hospital, APHP, University Paris VII, Clichy, France.
Abstract
BACKGROUND: Although laparoscopic pancreatic resection (LPR) has become routine, large single-center series are still lacking. Our aim was to analyze the results of a large European single-center series of LPR. STUDY DESIGN: Between January 2008 and September 2015, 300 LPRs were performed and studied prospectively, including 165 (55%) distal pancreatectomies, 68 (23%) pancreaticoduodenectomies (PDs), 30 (10%) enucleations, 35 (11%) central pancreatectomies, and 2 (1%) total pancreatectomies. RESULTS: Mean age was 54 ± 15.4 years old (range 17 to 87 years), and most patients were women (58%). Laparoscopic pancreatic resection was performed for malignancy (46%), low potential malignant (44%), or benign (10%) diseases. The mean operative durations were 211 ± 102 minutes (range 30 to 540 minutes) for the entire population and 351 ± 59 minutes (range 240 to 540 minutes) for PD, and decreased with the learning curve. Mean blood loss was 229 ± 269 mL (range 0 to 1,500 mL), and 13 patients (4%) received transfusions. Conversion to an open procedure was required in 12 patients (4%), and only 5 in the last 250 patients (14% vs 2%; p < 0.001). Mortality occurred in 4 (1.3%) patients and only after PD (5.8%). Common complications were pancreatic fistula (n = 124, 41%), bleeding (n = 35, 12%), and reoperation (n = 28, 9%). The postoperative outcomes were less favorable in procedures with a reconstruction phase (n = 105) than in those without (n = 195), with increased mortality (3.8% vs 0%; p = 0.04), overall morbidity (76% vs % 52%; p < 0.001), and mean hospital stay (26 ± 15 days vs 16 ± 10 days; p < 0.001). CONCLUSIONS: Laparoscopic pancreatic resection without a reconstruction phase has excellent outcomes; LPR with a reconstruction phase, especially PD, has less favorable outcomes, and further randomized studies are required to draw conclusions on the safety and benefits of this approach.
BACKGROUND: Although laparoscopic pancreatic resection (LPR) has become routine, large single-center series are still lacking. Our aim was to analyze the results of a large European single-center series of LPR. STUDY DESIGN: Between January 2008 and September 2015, 300 LPRs were performed and studied prospectively, including 165 (55%) distal pancreatectomies, 68 (23%) pancreaticoduodenectomies (PDs), 30 (10%) enucleations, 35 (11%) central pancreatectomies, and 2 (1%) total pancreatectomies. RESULTS: Mean age was 54 ± 15.4 years old (range 17 to 87 years), and most patients were women (58%). Laparoscopic pancreatic resection was performed for malignancy (46%), low potential malignant (44%), or benign (10%) diseases. The mean operative durations were 211 ± 102 minutes (range 30 to 540 minutes) for the entire population and 351 ± 59 minutes (range 240 to 540 minutes) for PD, and decreased with the learning curve. Mean blood loss was 229 ± 269 mL (range 0 to 1,500 mL), and 13 patients (4%) received transfusions. Conversion to an open procedure was required in 12 patients (4%), and only 5 in the last 250 patients (14% vs 2%; p < 0.001). Mortality occurred in 4 (1.3%) patients and only after PD (5.8%). Common complications were pancreatic fistula (n = 124, 41%), bleeding (n = 35, 12%), and reoperation (n = 28, 9%). The postoperative outcomes were less favorable in procedures with a reconstruction phase (n = 105) than in those without (n = 195), with increased mortality (3.8% vs 0%; p = 0.04), overall morbidity (76% vs % 52%; p < 0.001), and mean hospital stay (26 ± 15 days vs 16 ± 10 days; p < 0.001). CONCLUSIONS: Laparoscopic pancreatic resection without a reconstruction phase has excellent outcomes; LPR with a reconstruction phase, especially PD, has less favorable outcomes, and further randomized studies are required to draw conclusions on the safety and benefits of this approach.
Authors: MaryJoe K Rice; Jacob C Hodges; Johanna Bellon; Jeffrey Borrebach; Amr I Al Abbas; Ahmad Hamad; L Mark Knab; A James Moser; Amer H Zureikat; Herbert J Zeh; Melissa E Hogg Journal: JAMA Surg Date: 2020-07-01 Impact factor: 14.766
Authors: Brian K Goh; Tze Yi Low; Ye Xin Koh; Ser Yee Lee; Jin-Yao Teo; Juinn Huar Kam; Prema Raj Jeyaraj; Peng-Chung Cheow; Pierce K Chow; London L Ooi; Alexander Y Chung; Chung Yip Chan Journal: J Minim Access Surg Date: 2020 Oct-Dec Impact factor: 1.407