Ann Hepatobiliary Pancreat Surg.  2024 May;28(2):220-228. 10.14701/ahbps.23-144.

Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis

• Anand U
• Kodali R
• Parasar K
• Singh BN
• Kant K
• Yadav S
• Anwar S
• Arora A

• KMID: 2555932
• DOI: http://doi.org/10.14701/ahbps.23-144

Abstract

Backgrounds/Aims
Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD).
Methods
A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared.
Results
The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, p = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups.
Conclusions
LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.

Keyword

Pancreaticoduodenectomy; Propensity score; Laparoscopy

Figure

• 

  Fig. 1 Flow diagram of patient inclusion criteria. PD, pancreaticoduodenectomy; OPD, open pancreaticoduodenectomy; LAPD, laparoscopic assisted pancreaticoduodenectomy; BMI, body mass index; SPEN, solid pseudopapillary epithelial neoplasm.

Reference

References

1. Whipple AO, Parsons WB, Mullins CR. 1935; Treatment of carcinoma of the ampulla of vater. Ann Surg. 102:763–779. DOI: 10.1097/00000658-193510000-00023. PMID: 17856666. PMCID: PMC1391173.

2. Whipple AO. 1946; Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet. 82:623–631.

3. Kendrick ML, van Hilst J, Boggi U, de Rooij T, Walsh RM, Zeh HJ, et al. 2017; Minimally invasive pancreatoduodenectomy. HPB (Oxford). 19:215–224. DOI: 10.1016/j.hpb.2017.01.023. PMID: 28317658.

4. Wei H, Wei B, Zheng Z, Huang Y, Huang J, Fang J. 2014; [Comparative study of outcomes after laparoscopic versus open pancreaticoduodenectomy]. Zhonghua Wei Chang Wai Ke Za Zhi. 17:465–468. Chinese.

5. Lau K, Salami A, Barden G, Khawja S, Castillo DL, Poppelaars V, et al. 2014; The effect of a regional hepatopancreaticobiliary surgical program on clinical volume, quality of cancer care, and outcomes in the Veterans Affairs system. JAMA Surg. 149:1153–1161. DOI: 10.1001/jamasurg.2014.1711. PMID: 25207711.

6. Schmidt CM, Turrini O, Parikh P, House MG, Zyromski NJ, Nakeeb A, et al. 2010; Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 145:634–640. DOI: 10.1001/archsurg.2010.118. PMID: 20644125.

7. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. 2005; Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 138:8–13. DOI: 10.1016/j.surg.2005.05.001. PMID: 16003309.

8. Ricci C, Casadei R, Taffurelli G, Pacilio CA, Ricciardiello M, Minni F. 2018; Minimally invasive pancreaticoduodenectomy: what is the best "choice"? A systematic review and network meta-analysis of non-randomized comparative studies. World J Surg. 42:788–805. DOI: 10.1007/s00268-017-4180-7. PMID: 28799046.

9. Poves I, Burdío F, Morató O, Iglesias M, Radosevic A, Ilzarbe L, et al. 2018; Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Ann Surg. 268:731–739. DOI: 10.1097/SLA.0000000000002893. PMID: 30138162.

10. Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DG, et al. 2015; Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg. 262:372–377. DOI: 10.1097/SLA.0000000000001055. PMID: 26158612.

11. Palanivelu C, Senthilnathan P, Sabnis SC, Babu NS, Srivatsan Gurumurthy S, Anand Vijai N, et al. 2017; Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg. 104:1443–1450. DOI: 10.1002/bjs.10662. PMID: 28895142.

12. Tian F, Wang YZ, Hua SR, Liu QF, Guo JC. 2020; Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy. BMC Surg. 20:89. DOI: 10.1186/s12893-020-00752-5. PMID: 32375728. PMCID: PMC7201709.

13. Son TQ, Hoc TH, Quyet NT, Giang TB, Hung NN, Tung TT, et al. 2021; Efficacy of laparoscopic-assisted pancreaticoduodenectomy in Vietnamese patients with periampullary of Vater malignancies: a single-institution prospective study. Ann Med Surg (Lond). 69:102742. DOI: 10.1016/j.amsu.2021.102742. PMID: 34504691. PMCID: PMC8417344.

14. Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, et al. 2009; Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg. 198:445–449. DOI: 10.1016/j.amjsurg.2008.12.025. PMID: 19342003.

15. Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, et al. 2017; Pancreatic adenocarcinoma, version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 15:1028–1061. DOI: 10.6004/jnccn.2017.0131. PMID: 28784865.

16. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. 2017; The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 161:584–591. DOI: 10.1016/j.surg.2016.11.014. PMID: 28040257.

17. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. 2007; Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 142:761–768. DOI: 10.1016/j.surg.2007.05.005. PMID: 17981197.

18. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. 2007; Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 142:20–25. DOI: 10.1016/j.surg.2007.02.001. PMID: 17629996.

19. Adsay NV, Basturk O, Saka B, Bagci P, Ozdemir D, Balci S, et al. 2014; Whipple made simple for surgical pathologists: orientation, dissection, and sampling of pancreaticoduodenectomy specimens for a more practical and accurate evaluation of pancreatic, distal common bile duct, and ampullary tumors. Am J Surg Pathol. 38:480–493. DOI: 10.1097/PAS.0000000000000165. PMID: 24451278. PMCID: PMC4051141.

20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. 1987; A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 40:373–483. DOI: 10.1016/0021-9681(87)90171-8. PMID: 3558716.

21. Kendrick ML, Cusati D. 2010; Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 145:19–23. DOI: 10.1001/archsurg.2009.243.

22. Gagner M, Pomp A. 1994; Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 8:408–410. DOI: 10.1007/BF00642443. PMID: 7915434.

23. Zhao Z, Yin Z, Hang Z, Ji G, Feng Q, Zhao Q. 2017; A systemic review and an updated meta-analysis: minimally invasive vs open pancreaticoduodenectomy. Sci Rep. 7:2220. DOI: 10.1038/s41598-017-02488-4. PMID: 28533536. PMCID: PMC5440387.

24. Deichmann S, Bolm LR, Honselmann KC, Wellner UF, Lapshyn H, Keck T, et al. 2018; Perioperative and long-term oncological results of minimally invasive pancreatoduodenectomy as hybrid technique - a matched pair analysis of 120 cases. Zentralbl Chir. 143:155–161. DOI: 10.1055/s-0043-124374. PMID: 29719907. PMCID: PMC6193412.

25. Pędziwiatr M, Małczak P, Pisarska M, Major P, Wysocki M, Stefura T, et al. 2017; Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis. Langenbecks Arch Surg. 402:841–851. DOI: 10.1007/s00423-017-1583-8. PMID: 28488004. PMCID: PMC5506213.

26. van Hilst J, de Rooij T, Bosscha K, Brinkman DJ, van Dieren S, Dijkgraaf MG, et al. 2019; Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol. 4:199–207. DOI: 10.1016/S2468-1253(19)30004-4. PMID: 30685489.

27. Klompmaker S, van Hilst J, Wellner UF, Busch OR, Coratti A, D'Hondt M, et al. 2020; Outcomes after minimally-invasive versus open pancreatoduodenectomy: a pan-european propensity score matched study. Ann Surg. 271:356–363. DOI: 10.1097/SLA.0000000000002850. PMID: 29864089.

28. Kuroki T, Adachi T, Okamoto T, Kanematsu T. 2012; A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepatogastroenterology. 59:570–573. DOI: 10.5754/hge11351. PMID: 21940382.

29. Suzuki O, Kondo S, Hirano S, Tanaka E, Kato K, Tsuchikawa T, et al. 2012; Laparoscopic pancreaticoduodenectomy combined with minilaparotomy. Surg Today. 42:509–513. DOI: 10.1007/s00595-011-0064-x. PMID: 22127534.

30. Zeh HJ, Zureikat AH, Secrest A, Dauoudi M, Bartlett D, Moser AJ. 2012; Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol. 19:864–870. DOI: 10.1245/s10434-011-2045-0. PMID: 21947670.

31. Chalikonda S, Aguilar-Saavedra JR, Walsh RM. 2012; Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc. 26:2397–2402. DOI: 10.1007/s00464-012-2207-6. PMID: 22437947.

32. Wellner UF, Küsters S, Sick O, Busch C, Bausch D, Bronsert P, et al. 2014; Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients. Langenbecks Arch Surg. 399:849–856. DOI: 10.1007/s00423-014-1236-0. PMID: 25074409.

33. Mendoza AS 3rd, Han HS, Yoon YS, Cho JY, Choi Y. 2015; Laparoscopy-assisted pancreaticoduodenectomy as minimally invasive surgery for periampullary tumors: a comparison of short-term clinical outcomes of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. J Hepato-Biliary-Pancreat Sci. 22:819–824. DOI: 10.1002/jhbp.289. PMID: 26455716.

34. Dokmak S, Ftériche FS, Aussilhou B, Bensafta Y, Lévy P, Ruszniewski P, et al. 2015; Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 220:831–838. DOI: 10.1016/j.jamcollsurg.2014.12.052. PMID: 25840531.

35. Bablekos GD, Roussou T, Rasmussen T, Vassiliou MP, Behrakis PK. 2003; Postoperative changes on pulmonary function after laparoscopic and open cholecystectomy. Hepatogastroenterology. 50:1193–1200.

36. Cone MM, Herzig DO, Diggs BS, Rea JD, Hardiman KM, Lu KC. 2012; Effect of surgical approach on 30-day mortality and morbidity after elective colectomy: a NSQIP study. J Gastrointest Surg. 16:1212–1217. DOI: 10.1007/s11605-012-1860-3. PMID: 22402957.

37. Wang Y, Bergman S, Piedimonte S, Vanounou T. 2014; Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach. Can J Surg. 57:263–270. DOI: 10.1503/cjs.026713. PMID: 25078932. PMCID: PMC4119119.

38. Zureikat AH, Breaux JA, Steel JL, Hughes SJ. 2011; Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg. 15:1151–1157. DOI: 10.1007/s11605-011-1530-x. PMID: 21538192.

39. Asbun HJ, Stauffer JA. 2012; Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 215:810–819. DOI: 10.1016/j.jamcollsurg.2012.08.006. PMID: 22999327.

40. Wang M, Peng B, Liu J, Yin X, Tan Z, Liu R, et al. 2021; Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: a retrospective multicenter analysis of 1029 patients. Ann Surg. 273:145–153. DOI: 10.1097/SLA.0000000000003190. PMID: 30672792.

41. Nassour I, Wang SC, Christie A, Augustine MM, Porembka MR, Yopp AC, et al. 2018; Minimally invasive versus open pancreaticoduodenectomy: a propensity-matched study from a national cohort of patients. Ann Surg. 268:151–157. DOI: 10.1097/SLA.0000000000002259. PMID: 28486387.

42. Lu C, Jin W, Mou YP, Zhou J, Xu X, Xia T, et al. 2016; Analysis of learning curve for laparoscopic pancreaticoduodenectomy. J Vis Surg. 2:145. DOI: 10.21037/jovs.2016.07.25. PMID: 29078532. PMCID: PMC5637755.

43. Vladimirov M, Bausch D, Stein HJ, Keck T, Wellner U. 2022; Hybrid laparoscopic versus open pancreatoduodenectomy. A meta-analysis. World J Surg. 46:901–915. DOI: 10.1007/s00268-021-06372-1. PMID: 35043246. PMCID: PMC8885482.

44. Fatima J, Schnelldorfer T, Barton J, Wood CM, Wiste HJ, Smyrk TC, et al. 2010; Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival. Arch Surg. 145:167–172. DOI: 10.1001/archsurg.2009.282. PMID: 20157085.

45. Hakeem AR, Verbeke CS, Cairns A, Aldouri A, Smith AM, Menon KV. 2014; A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol. Hepatobiliary Pancreat Dis Int. 13:435–441. DOI: 10.1016/S1499-3872(14)60048-5. PMID: 25100130.