Total laparoscopic pancreaticoduodenectomy feasibility and outcome in an early experience

Michael L. Kendrick, Daniel Cusati

Research output: Contribution to journalArticle

234 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)19-23
Number of pages5
JournalArchives of Surgery
Volume145
Issue number1
DOIs
StatePublished - Jan 2010

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Pancreaticoduodenectomy
Length of Stay
Operative Time
Adenocarcinoma
Pancreaticojejunostomy
Cystadenoma
Morbidity
Pancreatic Fistula
Learning Curve
Neuroendocrine Tumors
Cholangiocarcinoma
Gastric Emptying
Chronic Pancreatitis
Hospital Mortality
Tertiary Care Centers
Venous Thrombosis
Adenoma
Sutures
Neoplasms
Mucous Membrane

ASJC Scopus subject areas

  • Surgery

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Total laparoscopic pancreaticoduodenectomy feasibility and outcome in an early experience. / Kendrick, Michael L.; Cusati, Daniel.

In: Archives of Surgery, Vol. 145, No. 1, 01.2010, p. 19-23.

Research output: Contribution to journalArticle

Kendrick, Michael L. ; Cusati, Daniel. / Total laparoscopic pancreaticoduodenectomy feasibility and outcome in an early experience. In: Archives of Surgery. 2010 ; Vol. 145, No. 1. pp. 19-23.
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abstract = "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.",
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