Download PDF
CC BY-NC-ND 4.0 · Zentralbl Chir 2018; 143(02): 155-161
DOI: 10.1055/s-0043-124374
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

Article in several languages: English | deutsch
Steffen Deichmann   *   *
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
,
Louisa Romina Bolm   *   *
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
,
Kim Christin Honselmann
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
,
Ulrich Friedrich Wellner
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
,
Hryhoriy Lapshyn
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
,
Tobias Keck   **   **
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
,
Dirk Bausch   **   **
Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein – Campus Lübeck, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 May 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background Laparoscopic pancreatoduodenectomy is a highly challenging procedure. The aim of this study was to analyse post-operative morbidity and mortality as well as long term overall survival in patients undergoing hybrid LPD, as compared to open pancreaticoduodenecomy (OPD) in a single surgeon series.

Methods Patients undergoing pancreatoduodenectomy (PD) in the period from 2000 to 2015 were identified from a prospectively maintained database. All LPD procedures were performed by one specialised pancreatic surgeon (TK). Patients were matched 1 : 1 for age, sex, BMI, ASA, histological diagnosis, pancreatic texture and portal venous resection (PVR). All LPD procedures were performed as hybrid LPD – combining laparoscopic resection and open reconstruction via mini laparotomy.

Results A total of 549 patients were identified, including 489 patients in the OPD group and 60 patients in the LPD group. 60 patients were identified who underwent LPD between 2010 and 2015 versus 60 OPD patients operated in the same period. Median overall operation time was shorter in the LPD group than with OPD patients (LPD 352 vs. OPD 397 min; p = 0.002). Overall transfusion units were lower in the LPD group (LPD range 0 – 4 vs. OPD range 0 – 11; p = 0.032). Intensive care unit stay (LPD 1 vs. OPD 6 d; p = 0.008) and overall hospital stay (OHS: LPD 14 vs. OPD 18 d; p = 0.012) were shorter in the LPD groups than in the OPD group. As regards postoperative complications, LPD was associated with reduced rates of clinically relevant grade B/C postoperative pancreatic fistula (LPD 15 vs. OPD 36%; p = 0.036) and grade B/C delayed gastric emptying (LPD 8 vs. OPD 20%; p = 0.049). A total of 56 patients were diagnosed with malignant disease. The number of harvested lymph nodes and R0-resection rates were equal for LPD and OPD patients. LPD patients showed a trend to improved median overall survival (LPD mean 56 months vs. OPD mean 48 months; p = 0.056).

Conclusion Hybrid LPD is a safe procedure associated with a reduction in clinically relevant postoperative complications and allows faster recovery. Long term oncological outcome of hybrid LPD for malignant disease is equal to that with the standard open approach.

Key words

abdominal surgery - laparoscopic surgery - pancreatic head resection - pancreatic surgery - hybrid laparoscopic pancreatoduodenectomy

* S. Deichmann und L. Bolm trugen zu gleichen Teilen zu dieser Arbeit bei und teilen die Erstautorenschaft.


** T. Keck und D. Bausch trugen zu gleichen Teilen zu dieser Arbeit bei und teilen die Seniorautorenschaft.


 

  • References/Literatur

  • 1 Bausch D, Keck T. Laparoscopic pancreatic resections. Langenbecks Arch Surg 2013; 398: 939-945
    CrossrefPubMedGoogle Scholar
  • 2 Guillou PJ, Quirke P, Thorpe H. et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365: 1718-1726
    CrossrefPubMedGoogle Scholar
  • 3 Postlewait LM, Kooby DA. Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?. J Gastrointest Oncol 2015; 6: 406
    PubMedGoogle Scholar
  • 4 Nakamura M, Nakashima H. Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 2013; 20: 421-428
    CrossrefPubMedGoogle Scholar
  • 5 Sharpe SM, Talamonti MS, Wang CE. et al. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg 2015; 221: 175-184
    CrossrefPubMedGoogle Scholar
  • 6 Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994; 8: 408-410
    CrossrefPubMedGoogle Scholar
  • 7 Zureikat AH, Moser AJ, Boone BA. et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg 2013; 258: 554-562
    PubMedGoogle Scholar
  • 8 de Rooij T, Lu MZ, Steen MW. et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg 2016; 264: 257-267
    CrossrefPubMedGoogle Scholar
  • 9 Correa-Gallego C, Dinkelspiel HE, Sulimanoff I. et al. Minimally-invasive vs. open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 2014; 218: 129-139
    CrossrefPubMedGoogle Scholar
  • 10 Croome KP, Farnell MB, Que FG. et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?. Ann Surg 2014; 260: 633-640
    CrossrefPubMedGoogle Scholar
  • 11 Stauffer JA, Coppola A, Villacreses D. et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc 2017; 31: 2233-2241
    CrossrefPubMedGoogle Scholar
  • 12 Nigri G, Petrucciani N, La Torre M. et al. Duodenopancreatectomy: open or minimally invasive approach?. Surgeon 2014; 12: 227-234
    CrossrefPubMedGoogle Scholar
  • 13 Boggi U, Amorese G, Vistoli F. et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc 2015; 29: 9-23
    CrossrefPubMedGoogle Scholar
  • 14 Wellner UF, Küsters S, Sick O. et al. Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbecks Arch Surg 2014; 399: 849-856
    CrossrefPubMedGoogle Scholar
  • 15 Bassi C, Dervenis C, Butturini G. et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138: 8-13
    CrossrefPubMedGoogle Scholar
  • 16 Wente MN, Bassi C, Dervenis C. et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142: 761-768
    CrossrefPubMedGoogle Scholar
  • 17 Grützmann R, Rückert F, Hippe-Davies N. et al. Evaluation of the International Study Group of Pancreatic Surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery 2012; 151: 612-620
    CrossrefPubMedGoogle Scholar
  • 18 Venkat R, Edil BH, Schulick RD. et al. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 2012; 255: 1048-1059
    CrossrefPubMedGoogle Scholar
  • 19 Pericleous S, Middleton N, McKay SC. et al. Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure?. Pancreas 2012; 41: 993-1000
    CrossrefPubMedGoogle Scholar
  • 20 Sharpe SM, Talamonti MS, Wang E. et al. The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg 2015; 209: 557-563
    CrossrefPubMedGoogle Scholar
  • 21 Speicher PJ, Nussbaum DP, White RR. et al. Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol 2014; 21: 4014-4019
    CrossrefPubMedGoogle Scholar
  • 22 Asbun HJ, Stauffer JA. Laparoscopic vs. open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 2012; 215: 810-819
    CrossrefPubMedGoogle Scholar
  • 23 Dokmak S, Ftériche FS, Aussilhou B. et al. The largest European single-center experience: 300 laparoscopic pancreatic resections. J Am Coll Surg 2017; 225: 226-234.e2
    CrossrefPubMedGoogle Scholar
  • 24 Zhang J, Wu WM, You L. et al. Robotic versus open pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 2013; 20: 1774-1780
    CrossrefPubMedGoogle Scholar
  • 25 Chen S, Chen JZ, Zhan Q. et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 2015; 29: 3698-3711
    CrossrefPubMedGoogle Scholar
  • 26 Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy – a comparative study. Int J Surg 2012; 10: 475-479
    CrossrefPubMedGoogle Scholar
  • 27 Tee MC, Croome KP, Shubert CR. et al. Laparoscopic pancreatoduodenectomy does not completely mitigate increased perioperative risks in elderly patients. HPB (Oxford) 2015; 17: 909-918
    CrossrefPubMedGoogle Scholar
  • 28 Marjanovic G, Kuvendziska J, Holzner PA. et al. A prospective clinical study evaluating the development of bowel wall edema during laparoscopic and open visceral surgery. J Gastrointest Surg 2014; 18: 2149-2154
    CrossrefPubMedGoogle Scholar
  • 29 Crippa S, Cirocchi R, Randolph J. et al. Pancreaticojejunostomy is comparable to pancreaticogastrostomy after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2016; 401: 427-437
    CrossrefPubMedGoogle Scholar
  • 30 Lillemoe KD, Yeo CJ, Cameron JL. Pancreatic cancer: state-of-the-art care. CA Cancer J Clin 2000; 50: 241-268
    CrossrefPubMedGoogle Scholar
  • 31 Hu BY, Wan T, Zhang WZ. et al. Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy. World J Gastroenterol 2016; 22: 7797
    CrossrefPubMedGoogle Scholar