Laparoscopic pancreaticoduodenectomy a feasible oncological intervention

Laparoscopic pancreaticoduodenectomy (LPD) is associated with high rates of early morbidity, reoperation, and transition to laparotomy, reports a recent study. Nevertheless, LPD remains a viable alternative to open pancreaticoduodenectomy (OPD).

Researchers conducted a retrospective analysis of 149 patients of whom 57 (mean age 51.7 years) underwent LPD while 77 (mean age 56.5 years) received OPD. Of the LPD patients, 15 eventually converted to OPD.

Procedurally, LPD patients saw a significantly longer operative time (300 vs 240 mins; p<0.001), but required significantly lower intraoperative blood transfusion (214.04 vs 508.7 mL; p=0.015) than OPD comparators. The overall blood loss, however, was statistically comparable (p=0.356). Length of postoperative hospital stay was longer in LPD (14 vs 12; p=0.034).

In the short-term, LPD led to a significantly higher rate of bile leakage (7.0 percent vs 0 percent; p=0.02) and reoperation (12.3 percent vs 3.2 percent; p=0.044), as opposed to OPD. No such pattern was reported for other complications such as abdominal wall infections and chylous leakage.

Nevertheless, over the follow-up period, LPD was able to match OPD in terms of overall survival (46.5 vs 42.2 months; p=0.833), an effect that was not significantly affected by the type of malignancy.

“With the high conversion rate to laparotomy, morbidity, and reoperation, it is impossible to demonstrate a clear benefit of LPD over OPD. Despite this, LPD is acceptable when accompanied by oncological treatment, and long-term survival is equivalent in LPD and OPD patients,” the researchers said.