Total laparoscopic pancreaticoduodenectomy feasibility and outcome in an early experience

Hypothesis: Total laparoscopic pancreaticoduodenectomy is a safe and effective therapeutic approach. Design: Single-institutional retrospective review. Setting: Tertiary referral center. Patients: All consecutive patients undergoing total laparoscopic pancreaticoduodenectomy from July 2007 through July 2009 at a single center (n=62). Main Outcome Measures: Blood loss, operative time, postoperative morbidity, length of hospital stay, and 30-day or in-hospital mortality. Results: Of 65 patients undergoing laparoscopic resection, 62 patients with a mean age of 66 years (SD, 12 years) underwent total laparoscopic pancreaticoduodenectomy. The pancreaticojejunostomy consisted of a ductto-mucosa anastomosis with interrupted suture. Median operative time was 368 minutes (range, 258-608 minutes) and median blood loss was 240 mL (range, 30-1200 mL). Diagnosis was pancreatic adenocarcinoma (n=31), intraductal papillary mucinous neoplasm (n=12), periampullary adenocarcinoma (n=8), neuroendocrine tumor (n=4), chronic pancreatitis (n=3), cholangiocarcinoma (n=1), metastatic renal cell carcinoma (n=1), cystadenoma (n=1), and duodenal adenoma (n=1). Median tumor size was 3 cm (range, 0.9-10.0 cm) and the median number of lymph nodes harvested was 15 (range, 6-31). Perioperative morbidity occurred in 26 patients and included pancreatic fistula (n=11), delayed gastric emptying (n=9), bleeding (n=5), and deep vein thrombosis (n=2). There was 1 postoperative mortality. Median length of hospital stay was 7 days (range, 4-69 days). Conclusions: Laparoscopic pancreaticoduodenectomy is feasible, safe, and effective. Outcomes appear comparable with those via the open approach; however, controlled trials are needed. Despite this series representing experience within the learning curve, laparoscopic pancreaticoduodenectomy holds promise for providing advantages seen with minimally invasive approaches in other procedures.