A Case-matched Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy.

BACKGROUND

The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may offer benefits over open surgery [open pancreaticoduodenectomy (OPD)]. The aim of this study was to compare the outcomes of these 2 approaches at a tertiary cancer center from the Middle East.

MATERIALS AND

METHODS

Fifty consecutive patients who underwent LPD (n=12) and OPD (n=38) between 2015 and 2018 were considered. One surgeon performed LPD for "all comers," while 3 other surgeons performed open surgery. Patients were randomly matched on a 1:2 basis for pathology (benign vs. malignant), malignancy size (±1 cm), and whether the pancreatic duct was dilated (>3 mm).

RESULTS

Six patients were excluded, leaving 44 patients, of whom 33 were matched (LPD n=11, OPD n=22). The groups were comparable for age (57 vs. 63 y, P=0.123) and sex distribution (female; 55% vs. 45%, P=0.721), tumor size (3 cm in each group), frequency of pancreatic duct dilatation (45% in each group), and malignant pathology (82% in each group). There were no conversions to open surgery. Although the operating time for LPD was significantly longer (680 vs. 313 min, P<0.0001), LPD was associated with significantly shorter primary (4.7 vs. 7.8 d, P<0.0001) and total hospital stay that included readmissions (4.7 vs. 8.9 d, P<0.0001). There were no significant differences in blood loss (200 vs. 325 mL, P=0.082), overall complication rate (36.4% vs. 59.1%, P=0.282), or clinically significant complications (9.1% vs. 22.2%, P=0.643) and readmissions (0 vs. 4 patients). In patients with malignant disease, there were no differences with regard to the number of lymph nodes retrieved (18 vs. 12, P=0.095) and frequency of R0 resections (77.8% in each group).

CONCLUSION

In experienced hands, the laparoscopic approach to pancreaticoduodenectomy seems to offer advantages over open surgery in terms of reduction in hospital stay while maintaining an equivalent oncologic resection.