A case matched study on laparoscopic versus open pancreaticoduodenectomy / 中华肝胆外科杂志

ABSTRACT

Objective To compare the clinical outcomes of total laparoscopic pancreatoduodenectomy (TLPD) and open pancreaticoduodenectomy (OPD).Methods From August 2013 to December 2014,137 pancreaticoduodenectomies (PDs) were performed at the Department of General Surgery of our hospital,of which 19 TLPDs were performed at the Department of Minimally Invasive Surgery (the Experimental group).At the same time,another cohort of 19 OPDs were matched for age,gender,body mass index (BMI),ASA score and tumor site and they formed the control group.The clinical data in the perioperative period were evaluated,and the short-term clinical outcomes were compared.Results Operation time in the experimental group was significantly longer than the control group [(407.8 ± 146.5)min vs (263.3 ± 65.3) rmin,P ＜ 0.05].The mean intraoperative blood loss [(309.7 ± 151.2)ml vs (509.4 ± 309.9)ml],mean intensive care time after surgery [(47.5 ±16.8)h vs (68.1 ± 19.1)h],mean postoperative time to pass flatus [(3.5 ± 1.1) d vs (4.3 ± 1.1) d],mean postoperative hospitalization stay [(8.8 ± 2.1) d vs (10.8 ± 2.3)d] and mean incision length [(5.1 ± 0.9)cm vs (14.4 ± 1.3)cm] in the experimental group were significantly different from the control group (P ＜ 0.05).There were no significant differences on the intraoperative R0 resection rates,intraoperative pathology,tumor size [(20.6 ± 9.6) mm vs (25.9 ± 10.2)mm],number of lymph node dissected [(17.7 ± 6.5) vs (19.4 ± 5.6)],complication rates,recurrence rates and mortality between the two groups (P ＞ 0.05).Conclusions TLPD had comparable safety and therapeutic outcome when compared with OPD.Moreover,TLPD has the advantages of less bleeding,smaller wounds and faster postoperative recovery.TLPD requires specialized appliances and equipments,better surgeon experience and patient selection to achieve a high success rate.