The feasibility and effectiveness of laparoscopic pylorus-preserving pancreatoduodenectomy: a single institution experience

Hua H Zhang, MD. West China Hospital of Sichuan University

Introduction: A retrospective review was performed to evaluate whether the laparoscopic pylorus-preserving Pancreatoduodenectomy (LPPPD) is superior to the laparoscopic Pancreatoduodenectomy (LPD) in terms of perioperative complications, as well as the survival rate 1 year after surgery.

Methods: The patients who performed the LPPPD and the LPD between January 2010 and September 2013 were included in this retrospective study. All the patients were divided into 2 groups based on their surgical procedures, each group was divided into 3 subgroups according to their pathology result. The data we collected concerning patients’ demographics, preoperative examinations, intraoperative findings, perioperative complications, hospitalization time after operation, pathological results, the mortality and recurrence rate in 1 year after discharge.

Results: In the study, 15 patients performed LPD, the other 19 patients performed LPPPD. The margins of all the patients were negative. There were no significant differences in age, gender, size of the tumor, operative time (490.00min VS 456.25min, P>0.05), postoperative hospitalization duration (15.40d VS 14.84d, P>0.05), postoperative gastrointestinal decompression time (3.08d VS 2.69d, P>0.05), pancreatic fistula, bile leakage, chylous fistula, gastrointestinal fistula, delayed gastric emptying, hospital charges and the survival rate in 1 year after discharge between the 2 groups. There were differences between the 2 groups in the intraoperative blood loss (219.33ml VS 164.69ml, P<0.05) and the anastomotic bleeding or peptic ulcer (p<0.05).

Conclusions: LPPPD is comparable to LPD in operative time, perioperative complications and survival rate in 1 year after discharge. Both procedures are feasible and effective to treat the periampullary carcinomas and pancreatic head carcinomas. But the LPPPD is superior to LPD in reducing the perioperative blood loss and decreasing the rate of the anastomotic bleeding or peptic ulcer.