Laparoscopy-Assisted versus Open Pancreaticoduodenectomy: A Comparative Study in an Early Canadian Experience

Yifan Wang, Sabrina Piedimonte, BSc, Simon Bergman, MD, MSc, Tsafrir Vanounou, MD, MBA

Department of Surgery, Jewish General Hospital, McGill University, Montreal, Canada

Introduction: Despite advances in minimally invasive surgery, the implementation of total laparoscopic pancreaticoduodenectomy (TLPD) remains controversial. The difficulty associated with performing intracorporeal anastomoses restricts its applicability in routine practice. To obviate this limitation, we performed laparoscopy-assisted pancreaticoduodenectomy (LAPD): a hybrid laparoscopic-open approach in which pancreaticoduodenal resection is achieved laparoscopically, while reconstruction is completed via an upper midline mini-laparotomy. LAPD combines the superior ergonomics and visualization of open pancreaticoduodenectomy (OPD) with the benefits of a minimally invasive approach. The aim of this study is to compare the patient and oncologic outcomes of LAPD to those of OPD in our early institutional experience to evaluate the indication for the hybrid approach.

Methods and Procedures: A retrospective comparative analysis was performed on 19 consecutive patients who underwent LAPD (n = 7) or OPD (n = 12) at the Jewish General Hospital between September 2009 and June 2012. All patients were operated on with curative intent for suspected pancreatic malignancy by a single experienced pancreatic surgeon. Demographic, perioperative, and outcome data were collected from a prospectively maintained database and analyzed for statistically significant differences between study groups using the student t test, Mann-Whitney U test and Fischer’s exact test, as appropriate.

Results: Compared to the OPD cohort, patients undergoing LAPD had similar demographic characteristics, co-morbidities and tumor size. No significant differences were observed in estimated blood loss, R0 resection rate, lymph node harvest and 30- or 90-day mortality. Incidence of pancreatic fistula, and occurrence of Clavien grade I/II and grade III/IV complications were comparable between groups. Although not statistically significant, a trend towards lower postoperative analgesic requirements was observed in the LAPD cohort. LAPD patients required significantly longer operative times (703 vs. 572 min; P = 0.035), but shorter lengths of hospitalization (9.5 vs. 15.5 days; P = 0.033) compared to their OPD counterparts.

Conclusions: Provided careful patient selection, LAPD is a safe alternative to conventional OPD, and can be implemented in a high-volume center without compromising patient outcomes. The hybrid procedure may increase the number of patients potentially benefiting from a minimally invasive approach with little learning curve transition for the operating surgeon. Larger patient series are required to determine the role of LAPD within the armamentarium of hepatobiliary surgeons.

Session: Poster Presentation

Program Number: P330

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