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Laparoscopic Pancreaticoduodenectomy: Changing the Management of Ampullary Neoplasms

Brandon C Chapman, MD, Irada Ibrahim-Zada, MD, Douglas M Overbey, MD, Alessandro Paniccia, MD, Cheryl Meguid, DNP, Brian Brauer, MD, Ana Gleisner, MD, Martin D McCarter, MD, Richard D Schulick, MD, Barish H Edil, MD. University of Colorado School of Medicine

INTRODUCTION: The purpose of this study is to present the largest reported series comparing open pancreaticoduodenectomy (OPD) to total laparoscopic pancreaticoduodenctomy (TLPD) in patients with ampullary neoplasms.

METHODS AND PROCEDURES: We retrospectively identified all patients at our institution that underwent OPD or TLPD for ampullary neoplasms from June 2012 to August 2016. Patient demographics and clinical information including intraoperative, postoperative, and oncologic outcomes were queried from the medical record. A Wilcoxon rank-sum (Mann-Whitney) test, student’s t-test, and chi-square analysis were used for comparison where appropriate.

RESULTS: We identified 48 patients with ampullary neoplasms (adenocarcinoma n=37, neuroendocrine tumor n=7, undifferentiated n=1, adenoma n=3) undergoing OPD (n=25) and TLPD (n=23). There were no differences in age, male gender, BMI, ASA class, and tumor size between the two groups (all p>0.05). The TLPD group had lower median intraoperative blood loss (300 vs. 500 mL, p<0.001) and shorter median operative times (314 vs. 359 minutes, p=0.024) compared to OPD. No patient required conversion to an open procedure. The TLPD group had lower rates of intraabdominal abscess (0% vs. 16.0%, p=0.045) compared to OPD and there was a trend towards lower wound infections in the TLPD group (8.7% vs. 28.0%, p=0.087). There was no difference in rates of pancreatic fistula, bile leak, delayed gastric emptying, hospital length of stay, and 90-day readmission between the two groups (all p>0.05). There were no 90-day perioperative deaths. The total number of lymph nodes and positive lymph nodes were similar between the two groups (p>0.05) and all patients had negative margins. Although not significant, patients in the TLPD group received adjuvant chemotherapy 4 days sooner than OPD (p=0.589). The proportion of patients being offered TLPD has also progressively increased every year over 5 years: 0% (2012) to 60% (2016).

CONCLUSIONS: TLPD in patients with ampullary neoplasms have less operative blood loss, shorter operative times, fewer postoperative intraabdominal abscesses, and a trend towards lower wound infections while having equivalent short-term oncologic outcomes compared to the traditional open approach. In our institution, there has been a trend towards the laparoscopic approach for ampullary neoplasms over the last 5 years.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 79608

Program Number: S150

Presentation Session: Minimally Invasive Surgery – World Tour

Presentation Type: Podium

41

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