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
