Igor Khatkov1, Roman Izrailov1, Pavel Tyutyunnik2, Artur Khisamov3, Alexey Andrianov1, Abe Fingerhut4. 1. Moscow Clinical Scientific Centre, Moscow, Russia; Moscow State University of Medicine and Dentistry, Moscow, Russia. 2. Moscow Clinical Scientific Centre, Moscow, Russia; Moscow State University of Medicine and Dentistry, Moscow, Russia. Electronic address: tiutiunnikk@gmail.com. 3. Moscow Clinical Scientific Centre, Moscow, Russia. 4. Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
Abstract
INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) remains one of the most challenging minimal invasive operations today. PATIENTS AND METHODS: Between January 2007 and December 2016, 197 patients were scheduled for LPD but 162 patients (from January 2007 to July 2016) were analysed in this cohort series. RESULTS: Total LPD concerned for 162 patients (five patients did not undergo PD and 12 underwent conversion): standard LPD in 104 patients (66%), and laparoscopic pylorus-preserving PD in 41 patients (26%). Median operative time was 415 (240-765) min. Median blood loss was 200 (50-2100) ml. Twelve patients required blood transfusion. Clinically relevant pancreatic fistula (ISGPF grades B and C) occurred in 21 (13%) patients: 16 (10.0%) grade B, and 5 (3%) grade C. Grades B and C delayed gastric emptying occurred in five patients each. Grades B and C post-pancreatectomy bleeding occurred in 9 (5.7%) and 3 (1.9%) patients, respectively. LPD was performed for 18 (11.4%) benign and 139 (88.5%) malignant lesions. Superior mesenteric and/or portal vein involvement required major venous resection in eight patients. The 90-day mortality 5.0%. The median overall survival for pancreatic ductal adenocarcinoma was 22.5 months. CONCLUSION: Morbidity and mortality for LPD are comparable to open procedures rates in the literature. Laparoscopic major venous resection is feasible and safe.
INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) remains one of the most challenging minimal invasive operations today. PATIENTS AND METHODS: Between January 2007 and December 2016, 197 patients were scheduled for LPD but 162 patients (from January 2007 to July 2016) were analysed in this cohort series. RESULTS: Total LPD concerned for 162 patients (five patients did not undergo PD and 12 underwent conversion): standard LPD in 104 patients (66%), and laparoscopic pylorus-preserving PD in 41 patients (26%). Median operative time was 415 (240-765) min. Median blood loss was 200 (50-2100) ml. Twelve patients required blood transfusion. Clinically relevant pancreatic fistula (ISGPF grades B and C) occurred in 21 (13%) patients: 16 (10.0%) grade B, and 5 (3%) grade C. Grades B and C delayed gastric emptying occurred in five patients each. Grades B and C post-pancreatectomy bleeding occurred in 9 (5.7%) and 3 (1.9%) patients, respectively. LPD was performed for 18 (11.4%) benign and 139 (88.5%) malignant lesions. Superior mesenteric and/or portal vein involvement required major venous resection in eight patients. The 90-day mortality 5.0%. The median overall survival for pancreatic ductal adenocarcinoma was 22.5 months. CONCLUSION: Morbidity and mortality for LPD are comparable to open procedures rates in the literature. Laparoscopic major venous resection is feasible and safe.