Laparoscopic Pancreaticoduodenectomy With Open Reconstruction: The Buddha's Middle Path.

IF 1.1 4区医学 Q3 SURGERY Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Pub Date : 2024-10-01 DOI:10.1097/SLE.0000000000001311

Ameet Kumar, Sumesh Kaistha, Rajesh Gangavatiker

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Abstract

Background: Laparoscopic pancreaticoduodenectomy (LPD) is not universally adopted because of its steep learning curve. Its technical complexity discourages many surgeons. We believe that laparoscopic pancreaticoduodenectomy with open reconstruction (LPOR) has all the benefits of LPD without its drawbacks and combines the ease of open surgery with the benefits of minimal access surgery. We assessed the feasibility and safety of LPOR and compared it with open pancreaticoduodenectomy (OPD), with the objectives being perioperative and short-term clinical/oncologic outcomes.

Methods: Retrospective review of prospectively maintained database; study period from January 2013 to December 2019. Till 2015, we did only OPD. In 2016, we started with LPD but soon switched to LPOR. The resection part was done laparoscopically and the reconstruction part was done through a 8-cm mini-laparotomy.

Results: We did 19 OPDs and 15 LPORs. Demographic data of the 2 groups were comparable. The duration of surgery was significantly longer in the LPOR group (360 vs. 410 min; P =0.01), whereas the blood loss and hospital stay were longer in the OPD group (520 vs. 360 mL; P =0.03 and 13 vs. 11 d; P =0.08, respectively). Clinically significant complication rates, including delayed gastric emptying and postoperative pancreatic fistulas, were not different in either group. No patients in the LPOR group had wound-related/pulmonary complications. Lymph node yield was similar in both groups (20 vs. 22) and we had 100% R0 resections.

Conclusions: LPOR was better than OPD in terms of short-term outcomes and was not inferior to OPD in terms of complications/oncologic outcomes.

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开放重建的腹腔镜胰十二指肠切除术：佛陀的中庸之道

背景：腹腔镜胰十二指肠切除术（LPD）因其学习曲线陡峭而未被普遍采用。其技术复杂性让许多外科医生望而却步。我们认为，腹腔镜胰十二指肠切除术（LPOR）具有腹腔镜胰十二指肠切除术（LPD）的所有优点，却没有其缺点，而且兼具开放手术的简便性和微创手术的优点。我们评估了LPOR的可行性和安全性，并将其与开放式胰十二指肠切除术（OPD）进行了比较，其目标是围手术期和短期临床/肿瘤学结果：对前瞻性数据库进行回顾性审查；研究时间为 2013 年 1 月至 2019 年 12 月。直到 2015 年，我们只做了 OPD。2016年，我们开始采用LPD，但很快又改用LPOR。切除部分在腹腔镜下完成，重建部分通过8厘米小切口完成：结果：我们进行了 19 例 OPD 和 15 例 LPOR。两组患者的人口统计学数据相当。LPOR 组的手术时间明显更长（360 分钟对 410 分钟；P=0.01），而 OPD 组的失血量和住院时间更长（分别为 520 毫升对 360 毫升；P=0.03 和 13 天对 11 天；P=0.08）。胃排空延迟和术后胰瘘等有临床意义的并发症发生率在两组中没有差异。LPOR组没有患者出现伤口相关/肺部并发症。两组的淋巴结率相似（20对22），我们的R0切除率为100%：结论：就短期疗效而言，LPOR优于OPD，就并发症/肿瘤疗效而言，LPOR也不逊色于OPD。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 医学-外科

CiteScore

2.00

自引率

10.00%

发文量

103

审稿时长

3-8 weeks

期刊介绍： Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.