Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution

John A. Stauffer, Alessandro Coppola, Diego Villacreses, Kabir Mody, Elizabeth Johnson, Zhuo Li, Horacio J. Asbun

Research output: Contribution to journalArticle

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Abstract

Background: Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period. Methods: From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed. Results: Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively. Conclusion: LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Sep 7 2016

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Pancreaticoduodenectomy
Adenocarcinoma
Survival
Lymph Nodes

Keywords

  • Laparoscopic pancreaticoduodenectomy
  • Laparoscopy
  • Pancreatic adenocarcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma : long-term results at a single institution. / Stauffer, John A.; Coppola, Alessandro; Villacreses, Diego; Mody, Kabir; Johnson, Elizabeth; Li, Zhuo; Asbun, Horacio J.

In: Surgical Endoscopy and Other Interventional Techniques, 07.09.2016, p. 1-9.

Research output: Contribution to journalArticle

Stauffer, John A. ; Coppola, Alessandro ; Villacreses, Diego ; Mody, Kabir ; Johnson, Elizabeth ; Li, Zhuo ; Asbun, Horacio J. / Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma : long-term results at a single institution. In: Surgical Endoscopy and Other Interventional Techniques. 2016 ; pp. 1-9.
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abstract = "Background: Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period. Methods: From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed. Results: Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 {\%}) patients and converted to open in 14 (24.1 {\%}). Neoadjuvant therapy was performed in 17 (8.8 {\%}) patients for OPD and 4 (6.9 {\%}) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 {\%}) and for LPD (67, 43, 43, 38 and 32 {\%}), respectively. Conclusion: LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.",
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T1 - Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma

T2 - long-term results at a single institution

AU - Stauffer, John A.

AU - Coppola, Alessandro

AU - Villacreses, Diego

AU - Mody, Kabir

AU - Johnson, Elizabeth

AU - Li, Zhuo

AU - Asbun, Horacio J.

PY - 2016/9/7

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N2 - Background: Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period. Methods: From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed. Results: Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively. Conclusion: LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.

AB - Background: Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period. Methods: From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed. Results: Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively. Conclusion: LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.

KW - Laparoscopic pancreaticoduodenectomy

KW - Laparoscopy

KW - Pancreatic adenocarcinoma

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