Consecutive 87 Cases of Laparoscopic Pancreatoduodenectomy: Changes of Clinical Outcomes and Its Implication for Clinical Application

Song Cheol Kim, MD, Hae Ran Ha, RN, Hae R Seo, RN, Gi B Song, MD, Yong S Jung, MD, Yong H Kim, MD, Jae Bum Park, MD, Duck J Han, MD, Yun B, Choi. Department of Surgery, University of Ulsan College of Medicine


Introduction Laparoscopic pancreaticoduodenectomy have been regarded as an one of most challenging laparoscopic surgery. There have been only a few reports on laparoscopic pancreaticoduodenectomy (LPD) from experienced centers, and many have reported unsatisfactory clinical outcomes. Moreover there are no analytical reports according to time experience and its clinical implication. Aim of this study is to analysis the clinical outcomes of consecutive 87 cases of laparoscopic pancreatoduodenectomy chronologically and clinical feasibility and effectiveness
Method: Eighty-seven patients with benign or malignant lesions of the pancreatic head underwent laparoscopic pancreaticoduodenectomy (LPD) with or without pylorus preservation from Jun 2007. Most of them were performed with totally intracorporeal method except initial 10 cases, which had been performed with extracorporeal pancreaticojejunostomy. Because our series were mainly benign and low grade malignant lesion in pancreatic head, we analyzed the technical safety and effectiveness ,apart from oncologic outcomes. We regard that this point of view is the first step for approving the safety and effectiveness of this complex procedure
Results: Main indications were benign or low grade malignant diseases, such as intraductal papillary mucinous neoplasm (IPMN, n=38), solitary pseudopapillary tumor (n=13), neuroendocrine tumor (n=13), and others. There were 7 cases of peri-amupllary carcinoma. Mean operation time was 8.4 hrs, which was decreased year by year from 9.3 hr in 2007 to 6.5 hr in 2011. Oral intake was started on postoperative 3 days. Mean hospital stay was 15.2 days. Hospital stay was also shortened annually from 20.2 days in 2007 to 10.2 days in 2011. There was one case of mortality from postoperative bleeding in early stage. Rate of total surgical complication showed 30.8%, including 6.1 % of pancreatic fistula (ISGPF criteria). Total morbidity was also reduced from 30 % in 2007 to 16% in 2011.When data after learning period (in 2011) compared to open PD performed during the same period, it did not show difference in terms of operation time and morbidity rate, and showed significantly shorter hospital stays and cosmetic effect
Conclusion: This study reflects that LPD after some learning period can be adopted as a safe and effective clinical procedure for selected pancreatic head lesions. However further well- designed studies remain as a key factor for the LPD to be a wide accepted clinical procedure


Session Number: SS03 – HPB (Hepatobiliary and Pancreas)
Program Number: S014

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