Laparoscopic Pancreatoduodenectomy with Venous Resection Is Safe Compared to Open Pancreatoduodenectomy: A Monocentric Comparative Study
(2023)
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- Abstract
- Background: Laparoscopic pancreatoduodenectomy (LPD) for pancreatic ductal adenocarcinoma (PDAC) is more frequently performed and few small series report on its feasibility with venous resection. In this study, we compared the outcomes of LPD and open PD (OPD) with venous resection. Method: In the study centre and since 2014, LPD with venous resection is performed in selected patients. We retrospectively analysed data from patients who underwent LPD or OPD for PDAC and venous resection between 2014 and 2022. In OPD group, we selected patients who could theoretically benefit from the laparoscopic approach. Results: Eighty nine patients were included, 21 (24%) LPD and 68 (76%) OPD. LPD compared to OPD showed similar median age (69 years and 67, p= 0.3), proportion of female patients (52% and 50%, p= 0.3), median body mass index (24 for both, p= 1.00) and less neoadjuvant chemoradiotherapy (43% versus 79%, p= 0.002). LPD had more lateral venous resections (90% vs 63%, p= 0.028), more reconstruction with autologous peritoneal patch (57% versus 19%, p= 0.002), longer median clamping time (28 vs 15 minutes, p< 0.001) and operative time (360 vs 255 minutes, p< 0.001). There was 1 (5%) venous reconstruction thrombosis in LPD patients and 6 (9%) in OPD patients with no difference (p= 1.00). The outcome showed 1 (5%) death in the OPD group and similar Clavien-Dindo ≥ 3 complications (LPD 14% vs OPD 16%, p= 0.236) and median hospital stay (14 days, p= 0.804). LPD and OPD showed similar T stage [T0 (5% vs 6%), T1/2 (62% vs 82%), T3 (33% vs 12%), p=0.336], median number of lymph nodes harvested (22 vs 23, p=0.893) and invaded (0, p= 0.306), R0 resection rate (81% vs 89%, p=0.286) and adjuvant chemotherapy (90% vs 78%, p=0.342). Conclusion: LPD with venous reconstruction for PDAC is feasible in selected patients and high volume centres with security profile and oncologic outcomes similar to OPD
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Karam, E., Aussilhou, B., Ftériche, F. S., Marique, L., Lesurtel, M., Sauvanet, A., & Dokmak, S. (2023). Laparoscopic Pancreatoduodenectomy with Venous Resection Is Safe Compared to Open Pancreatoduodenectomy: A Monocentric Comparative Study. HPB, 25, S459-S460. https://doi.org/10.1016/j.hpb.2023.07.558 (Original work published 2023)