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Kim HJ, Cho CK. Analysis of the learning curve for laparoscopic pancreaticoduodenectomy based on a single surgeon's experience: a retrospective observational study. Ann Surg Treat Res 2024; 107:27-34. [PMID: 38978686 PMCID: PMC11227916 DOI: 10.4174/astr.2024.107.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/24/2024] [Accepted: 04/19/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose Laparoscopic pancreaticoduodenectomy (LPD) is a highly challenging procedure, which prevents its widespread adoption despite its advantages of being a minimally invasive procedure. This study analyzed the learning curve for LPD based on a single surgeon's experience. Methods We retrospectively analyzed the medical records of 111 consecutive patients who underwent LPD by a single surgeon between March 2014 and October 2022. The learning curve was assessed using cumulative summation (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Surgical failure was defined as conversion to an open procedure or the occurrence of severe complications (Clavien-Dindo grade ≥III). Based on the learning curve analysis, we divided the learning curve into the early and late phases and compared the operative outcomes in each phase. Results Based on the CUSUM analysis, the operation time decreased after the first 33 cases. Based on the RA-CUSUM analysis, the LPD technique stabilized after the 44th case. In the late phase, operation time, length of stay, and incidence of delayed gastric emptying, severe complications, and surgical failure were significantly lower than in the early phase. Conclusion Our results indicate that 44 cases are required for stabilization of the LPD technique and improvement of operative outcomes.
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Affiliation(s)
- Hee Joon Kim
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Chol Kyoon Cho
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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2
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Xu S, Deng X, Wang S, Yu G, Liu J, Gong W. Short‑ and long‑term outcomes after laparoscopic and open pancreatoduodenectomy for elderly patients: a propensity score‑matched study. BMC Geriatr 2024; 24:462. [PMID: 38802742 PMCID: PMC11129404 DOI: 10.1186/s12877-024-05063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The feasibility and safety of laparoscopic pancreatoduodenectomy (LPD) in elderly patients is still controversial. This study aimed to compare the clinical outcomes of LPD and open pancreatoduodenectomy (OPD) in elderly patients. METHODS Clinical and follow-up data of elderly patients (≥ 65 years) who underwent LPD or OPD between 2015 and 2022 were retrospectively analyzed. A 1:1 propensity score-matching (PSM) analysis was performed to minimize differences between groups. Univariate and multivariate logistic regression analysis were used to select independent prognostic factors for 90-day mortality. RESULTS Of the 410 elderly patients, 236 underwent LPD and 174 OPD. After PSM, the LPD group had a less estimated blood loss (EBL) (100 vs. 200 mL, P < 0.001), lower rates of intraoperative transfusion (10.4% vs. 19.0%, P = 0.029), more lymph node harvest (11.0 vs. 10.0, P = 0.014) and shorter postoperative length of stay (LOS) (13.0 vs. 16.0 days, P = 0.013). There were no significant differences in serious complications, reoperation, 90-day readmission and mortality rates (all P > 0.05). Multivariate logistic regression analysis showed that post-pancreatectomy hemorrhage (PPH) was an independent risk factor for 90-day mortality. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) who underwent LPD or OPD had similar overall survival (OS) (22.5 vs.20.4 months, P = 0.672) after PSM. CONCLUSIONS It is safe and feasible for elderly patients to undergo LPD with less EBL and a shorter postoperative LOS. There was no statistically significant difference in long-term survival outcomes between elderly PDAC patients who underwent LPD or OPD.
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Affiliation(s)
- Shuai Xu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, Shandong, 250021, China
| | - Xin Deng
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, Shandong, 250021, China
| | - Shulin Wang
- Department of Rehabilitation Medicine, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250031, China
| | - Guangsheng Yu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, Shandong, 250021, China
| | - Jun Liu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, Shandong, 250021, China.
| | - Wei Gong
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, Shandong, 250021, China.
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Pham HM, Le Quan AT, Nguyen BH. Feasibility, safety and oncological short-term outcome of laparoscopic pancreaticoduodenectomy for periampullary cancer: Findings from a large sample from Vietnam. Medicine (Baltimore) 2024; 103:e37769. [PMID: 38608081 PMCID: PMC11018162 DOI: 10.1097/md.0000000000037769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Laparoscopic pancreaticoduodenectomy (LPD) is an alternative to open pancreaticoduodenectomy (OPD) for treatment of periampullary cancer in selected patients. However, this is a difficult procedure with a high complication rate. We conducted a prospective cohort study of 85 patients with suspected periampullary cancer who underwent LPD from February 2017 to January 2022 at University Medical Center at Ho Chi Minh City, Vietnam. Among these, 15 patients were excluded from the data analysis because of benign disease confirmed by postoperative pathological examination. Among 70 patients, the mean age was 58.9 ± 8.9 years old and 51.4% were female. The conversion rate to open surgery was 7.1% (n = 5). Among those underwent LPD, the mean operating time and estimated blood loss were 509 ± 94 minutes and 267 ± 102 mL, respectively. The median length of hospital stay was 8 days, interquartile range (IQR) 7-12 days. The percentage of cumulative morbidity, pancreatic fistula and major complication was 35.4%, 12.3%, and 13.8%, respectively. The median of comprehensive complication index (CCI) was 26.2 (IQR 20.9-29.6). Three patients required reoperation due to severe pancreatic fistula (n = 2) and necrotizing pancreatitis (n = 1). There was no death after ninety-day. The average number of harvested lymph nodes was 16.6 ± 5.1. The percentage of R0 resection was 100%. With properly selected patients, LPD can be a feasible, safe and effective approach with acceptable short-term outcomes.
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Affiliation(s)
- Hai Minh Pham
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh city, Vietnam
| | - Anh Tuan Le Quan
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh city, Vietnam
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam
| | - Bac Hoang Nguyen
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh city, Vietnam
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam
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Martin WT, Bonds M, Fischer L, Morris KT, Sarwar Z, Stewart K, Garwe T, Paniccia A, Schulick RD, Jain A, Edil BH. Learning Curve of a Laparoscopic Pancreaticoduodenectomy Program at a Second Institution. Am Surg 2024:31348241246163. [PMID: 38587270 DOI: 10.1177/00031348241246163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Historically, pancreaticoduodenectomy (PD) has been performed via a laparotomy, but increasingly, laparoscopic and robotic platforms are being employed for PD. Laparoscopic PD has a steep surgeon specific learning curve and programmatic elements that must be optimized. These factors may limit a surgeon who is proficient at laparoscopic PD to develop a program at another institution. We hypothesize that the learning curve for a surgeon transferring a program to a second institution is shorter than the initial laparoscopic PD learning curve for the same surgeon. METHODS A retrospective review of patients who underwent laparoscopic PD for any indication at the first institution (FI) from 2012 to 2017 and the second institution (SI) from 2018 to 2021 was conducted. Standard statistical analysis was performed. The learning curve was identified using one-sided CUSUM analysis of operative times. RESULT We identified 110 participants, 90 from the FI and 20 from the SI. More patients at the FI were diagnosed with periampullary adenocarcinoma on final pathology compared to the SI (65.6% vs 40.0%, P = .0132). FI operative times stabilized after the 25th laparoscopic PD and SI operative times stabilized after the 5th operation. No statistically significant difference was identified in postoperative complications. CONCLUSIONS The learning curve and average operative time of an SI laparoscopic PD program was shorter than the initial learning curve for a single surgeon with comparable outcomes. This suggests that complex minimally invasive surgical programs can be safely transferred to another high-volume institution without significant loss of progress.
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Affiliation(s)
- W Taylor Martin
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Morgan Bonds
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Laura Fischer
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Katherine T Morris
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoona Sarwar
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Kenneth Stewart
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Tabitha Garwe
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ajay Jain
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barish H Edil
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Cho SH, Seo DW, Oh D, Song TJ, Lee SK. Long-Term Outcomes of Endoscopic Ultrasound-Guided Ablation Vs Surgery for Pancreatic Cystic Tumors. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00303-3. [PMID: 38588765 DOI: 10.1016/j.cgh.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND & AIMS Endoscopic ultrasound-guided pancreatic cyst ablation (EUS-PCA) is performed as an alternative to surgical resection in selected patients with pancreatic cystic tumors (PCTs). We aimed to directly compare the long-term outcomes between EUS-PCA and surgery for PCTs. METHODS We reviewed a PCT database to identify patients with unilocular or oligolocular PCTs who underwent EUS-PCA or surgery between January 2004 and July 2019. We performed 1:1 propensity score matching based on potential confounding factors. The primary outcome was long-term morbidities. Secondary outcomes included early (≤14 days) and late (>14 days) major adverse events (MAEs), development of diabetes mellitus, readmission, length of hospital stay, and therapeutic efficacy. RESULTS A total of 620 patients (EUS-PCA, n = 310; surgery, n = 310) were selected after propensity score matching. The EUS-PCA group showed a lower 10-year rate of cumulative long-term morbidities (1.6% vs 33.5%; P = .001) as well as lower rates of early MAE (1.0% vs 8.7%; P = .001), late MAE (0.3% vs 5.5%; P = .001), and readmission (1.0% vs 15.2%; P = .001). The EUS-PCA group had a shorter hospital stay (3.5 vs 10.3 d; P = .001) and a lower incidence of diabetes mellitus (2.2% vs 22.8%; P = .001), whereas the surgery group had a higher complete resolution rate (76.5% vs 100%; P = .001) and a lower relapse rate (4.6% vs 0.3%; P = .001). CONCLUSIONS For select patients with PCTs, EUS-PCA showed superior results to surgery in terms of long-term safety profile and preservation of pancreatic function.
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Affiliation(s)
- Sung Hyun Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Jun Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kwon J, Kang CM, Jang JY, Yoon YS, Kwon HJ, Choi IS, Kim HJ, Shin SH, Kang SH, Moon HH, Hwang DW, Kim SC. Perioperative textbook outcomes of minimally invasive pancreatoduodenectomy: a multicenter retrospective cohort analysis in a Korean minimally invasive pancreatic surgery registry. Int J Surg 2024; 110:01279778-990000000-01290. [PMID: 38573082 DOI: 10.1097/js9.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The aim of this study is to investigate the perioperative composite textbook outcomes of pancreatic surgery after minimally invasive pancreatoduodenectomy (MIPD). MATERIALS AND METHODS The cohort study was conducted across 10 institutions and included 1552 patients who underwent MIPD registered with the Korean Study Group on Minimally Invasive Pancreatic Surgery between May 2007 and April 2020. We analyzed perioperative textbook outcomes of pancreatic surgery after MIPD. Subgroup analyses were performed to assess outcomes based on the hospital volume of MIPD. RESULTS Among all patients, 21.8% underwent robotic pancreatoduodenectomy. High-volume centers (performing >20 MIPD/year) performed 88.1% of the procedures. The incidence of clinically relevant postoperative pancreatic fistula was 11.5%. Severe complications (Clavien-Dindo grade ≥IIIa) occurred in 15.1% of the cases. The 90-day mortality rate was 0.8%. The mean hospital stay was 13.7 days. Textbook outcomes of pancreatic surgery success were achieved in 60.4% of patients, with higher rates observed in high-volume centers than in low-volume centers (62.2% vs. 44.7%, P<0.001). High-volume centers exhibited significantly lower conversion rates (5.4% vs. 12.5%, P=0.001), lower 90-day mortality (0.5% vs. 2.7%, P=0.001), and lower 90-day readmission rates (4.5% vs. 9.6%, P=0.006) than those low-volume centers. CONCLUSION MIPD could be performed safely with permissible perioperative outcomes, including textbook outcomes of pancreatic surgery, particularly in experienced centers. The findings of this study provided valuable insights for guiding surgical treatment decisions in periampullary disease.
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Affiliation(s)
- Jaewoo Kwon
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Chang Moo Kang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Hyung Jun Kwon
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon
| | - Hee Joon Kim
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sang Hyun Kang
- Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital
| | - Hyung Hwan Moon
- Department of Surgery, College of Medicine at Kosin University, Busan
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul
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Al Hussan M, Qiao S, Abuheit EMI, Abdun MA, Al Mahamid M, Guo H, Zheng F, Nobah AMAM. The Role of C-reactive Protein and Procalcitonin in Predicting the Occurrence of Pancreatic Fistula in Patients who Underwent Laparoscopic Pancreaticoduodenectomy: a Retrospective Study. Zentralbl Chir 2023; 148:508-515. [PMID: 37798903 DOI: 10.1055/a-2157-7550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The occurrence of postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy (LPD) is a significant concern, yet there is currently a lack of consensus on reliable predictive methods for this complication. Therefore, the aim of this study was to assess the clinical significance of C-reactive protein (CRP) and procalcitonin (PCT) values and their reliability in early predicting the development of clinically relevant pancreatic fistula (CRPF) following LPD.A retrospective analysis was conducted using data from 120 patients who had LPD between September 2019 and December 2021. Preoperative assessment data, standard patients' demographic and clinicopathological characteristics, intra- and postoperative evaluation, as well as postoperative laboratory values on postoperative days (PODs) 1, 3, and 7, including white blood cells (WBCs), CRP, and PCT, were prospectively recorded on a dedicated database. Two clinicians separately collected and cross-checked all of the data.Among 120 patients [77 men (64%), 43 women (36%], CRPF occurred in 15 patients (11 grade B and 4 grade C fistulas). The incidence rate of CRPF was 12.3%. A comparison of the median values of WBCs, PCT, and CRP across the two groups revealed that the CRPF group had higher values on most PODs than the non-CRPF group. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) and cutoff values. It was discovered that POD 3 has the most accurate and significant values for WBCs, CRP, and PCT. According to the ROC plots, the AUC for WBCs was 0.842, whereas the AUC for PCT was 0.909. As for CRP, the AUC was 0.941 (95% CI 0.899-0.983, p < 0.01) with a cutoff value of 203.45, indicating a sensitivity of 93.3% and specificity of 91.4%.Both CRP and PCT can be used to predict the early onset of CRPF following LPD, with CRP being slightly superior on POD 3.
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Affiliation(s)
- Maher Al Hussan
- Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China
| | - Shishi Qiao
- Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China
| | - Ezaldin M I Abuheit
- Cardiovascular Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mohammed Awadh Abdun
- Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China
| | - Mohamad Al Mahamid
- Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China
| | - Huahu Guo
- Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China
| | - Fengyu Zheng
- Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China
| | - Ali Mansour Ali Mi Nobah
- Cardiovascular Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Chen J, Pham H, Li C, Nahm CB, Johnston E, Hollands MJ, Pang T, Pleass H, Lam V, Richardson A, Yuen L. Evolution of laparoscopic pancreaticoduodenectomy at Westmead Hospital. ANZ J Surg 2023; 93:2648-2654. [PMID: 37772445 DOI: 10.1111/ans.18714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Despite its proposed benefits, laparoscopic pancreaticoduodenectomy (LPD) has not been widely adopted due to its technical complexity and steep learning curve. The aim of this study was to report a single surgeon's experience in the stepwise implementation of LPD and evolution of technique over a nine-year period in a moderate-high volume unit. METHODS Carefully selected patients underwent LPD initially by hybrid approach (laparoscopic resection and open reconstruction), which evolved into a total LPD (laparoscopic resection and reconstruction). Data was prospectively collected to include patient characteristics, intraoperative data, evolution of technique and postoperative outcomes. RESULTS A total of 25 patients underwent hybrid LPD (HLPD) and 20 patients underwent total LPD (TLPD). There was no 90-day mortality. Three patients developed a postoperative pancreatic fistula (POPF), all of which occurred in patients undergoing HLPD. There was no POPF in 20 consecutive TLPD. There was no evidence of anastomotic strictures in the hepaticojejunostomy in patients undergoing TLPD at long term follow up. CONCLUSION A gradual and cautious progression from HLPD to TLPD is essential to ensure safe implementation into a unit. LPD should only be considered in carefully selected patients, with outcomes subjected to regular and rigorous independent audit.
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Affiliation(s)
- Ji Chen
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen Pham
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - Crystal Li
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher B Nahm
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - Emma Johnston
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael John Hollands
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tony Pang
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - Henry Pleass
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - Vincent Lam
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Arthur Richardson
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Specialty of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, New South Wales, Australia
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Ji C, Li L, Liu Y, Wang S, Fu Y. A Short-Term Outcomes Comparison of Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy at Different Stages of Learning Curves: A Single Center Report. J Laparoendosc Adv Surg Tech A 2023; 33:949-956. [PMID: 37582273 DOI: 10.1089/lap.2023.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: With the development of surgical instruments and the growth of professional expertise over the past decades, laparoscopic pancreatoduodenectomy (LPD) is widely applied in different centers. However, there are still some controversies about the safety of this procedure. Meanwhile, perioperative outcomes are affected by hospital size, surgeon experience, and the learning curve. The purpose of this study is to compare the short-term outcomes of LPD with open pancreatoduodenectomy (OPD) at different stages of the learning curve. Methods: We retrospectively analyzed the clinical data of 911 patients who had received pancreatoduodenectomy (PD) at a single institution. Among them, 208 patients underwent OPD, and 703 cases received LPD successfully. We divided those patients into three phases based on the key point of the learning curve for LPD and compared the perioperative outcomes with OPD at each stage. Result: Morbidity and mortality rates associated with LPD were significantly higher in the initial stage than in the OPD group, whereas the number of harvested lymph nodes and R0 resection rate for pancreatic cancer were comparable to the OPD group. As surgical experience increased, postoperative complications, operating time, and intraoperative blood loss all are greatly decreased. At the mature stage of the learning curve, the rate of postoperative complications in LPD was lower than in the OPD group. Meanwhile, the length of hospital stay was significantly shortened compared to the OPD group. Conclusion: After a long period of training and learning, LPD can be performed safely. And LPD can produce comparable oncological results, with faster postoperative recovery and lower incidence of postoperative complications, after the surgeons successfully surmounted the learning curve.
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Affiliation(s)
- Chao Ji
- The First Operating Room, the First Hospital of Jilin University, Changchun, China
| | - Lin Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Shupeng Wang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yu Fu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
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Choi M, Lee JH, Roh YH, Kim H, Jang JY, Choi SH, Kang CM. Multidimensional Nomogram to Predict Postoperative Pancreatic Fistula after Minimally Invasive Pancreaticoduodenectomy. Ann Surg Oncol 2023; 30:5083-5090. [PMID: 37195514 DOI: 10.1245/s10434-023-13360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/01/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Clinically relevant postoperative pancreatic fistula (CR-POPF) is an inherently severe risk of pancreatic resection. Previous research has proposed models that identify risk factors and predict CR-POPF, although these are rarely applicable to minimally invasive pancreaticoduodenectomy (MIPD). This study aimed to evaluate the individual risks of CR-POPF and to propose a nomogram for predicting POPF in MIPD. PATIENTS AND METHODS We retrospectively reviewed the medical records of 429 patients who underwent MIPD. In the multivariate analysis, the Akaike information criterion stepwise logistic regression method was used to select the final model to develop the nomogram. RESULTS Of 429 patients, 53 (12.4%) experienced CR-POPF. On multivariate analysis, pancreatic texture (p = 0.001), open conversion (p = 0.008), intraoperative transfusion (p = 0.011), and pathology (p = 0.048) were identified as independent predictors of CR-POPF. The nomogram was developed based on patient, pancreatic, operative, and surgeon factors by using the following four additional clinical factors as variables: American Society of Anesthesiologists class ≥ III, size of pancreatic duct, type of surgical approach, and < 40 cases of MIPD experience. CONCLUSIONS A multidimensional nomogram was developed to predict CR-POPF after MIPD. This nomogram and calculator can help surgeons anticipate, select, and manage critical complications.
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Affiliation(s)
- Munseok Choi
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, South Korea
| | - Jae Hoon Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun Ho Roh
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeyeon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Young Jang
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sung Hoon Choi
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
| | - Chang Moo Kang
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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11
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Gregório C, Thakur S, Camara Rivero R, Márcia Dos Santos Machado S, Cuenin C, Carreira C, White V, Cree IA, Vukojevic K, Glavina Durdov M, Bersch Osvaldt A, Ashton-Prolla P, Herceg Z, Talukdar FR. Telomere length assessment and molecular characterization of TERT gene promoter in periampullary carcinomas. Gene 2023; 873:147460. [PMID: 37150235 DOI: 10.1016/j.gene.2023.147460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
Genetic and epigenetic alterations of the telomere maintenance machinery like telomere length and telomerase reverse transcriptase (encoded by TERT gene) are reported in several human malignancies. However, there is limited knowledge on the status of the telomere machinery in periampullary carcinomas (PAC) which are rare and heterogeneous groups of cancers arising from different anatomic sites around the ampulla of Vater. In the current study, we investigated the relative telomere length (RTL) and the most frequent genetic and epigenetic alterations in the TERT promoter in PAC and compared it with tumor-adjacent nonpathological duodenum (NDu). We found shorter RTLs (1.27 vs 1.33, P = 0.01) and lower TERT protein expression (p = 0.04) in PAC tissues as compared to the NDu. Although we did not find any mutation at two reactivating hotspot mutation sites of the TERT promoter, we detected polymorphism in 45% (9/20) of the cases at rs2853669 (T > C). Also, we found a hypermethylated region in the TERT promoter of PACs consisting of four CpGs (cg10896616 with Δβ 7%; cg02545192 with Δβ 9%; cg03323598 with Δβ 19%; and cg07285213 with Δβ 15%). In conclusion, we identified shorter telomeres with DNA hypermethylation in the TERT promoter region and lower TERT protein expression in PAC tissues. These results could be used further to investigate molecular pathology and develop theranostics for PAC.
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Affiliation(s)
- Cleandra Gregório
- Departamento de Genética, Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Shefali Thakur
- International Agency for Research on Cancer, Lyon, France; Faculty of Science, Charles University, Prague, Czech Republic
| | - Raquel Camara Rivero
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Serviço de Patologia- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Simone Márcia Dos Santos Machado
- Grupo de Vias Biliares e Pâncreas - Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cyrille Cuenin
- International Agency for Research on Cancer, Lyon, France
| | | | - Valerie White
- International Agency for Research on Cancer, Lyon, France
| | - Ian A Cree
- International Agency for Research on Cancer, Lyon, France
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, Croatia
| | | | - Alessandro Bersch Osvaldt
- Serviço de Patologia- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-graduação em Medicina: Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patricia Ashton-Prolla
- Departamento de Genética, Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Serviço de Patologia- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Zdenko Herceg
- International Agency for Research on Cancer, Lyon, France
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12
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Sattari SA, Sattari AR, Makary MA, Hu C, He J. Laparoscopic Versus Open Pancreatoduodenectomy in Patients With Periampullary Tumors: A Systematic Review and Meta-analysis. Ann Surg 2023; 277:742-755. [PMID: 36519444 DOI: 10.1097/sla.0000000000005785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of randomized controlled trials compared laparoscopic pancreatoduodenectomy (LPD) versus open pancreatoduodenectomy (OPD) in patients with periampullary tumors. BACKGROUND LPD has gained attention; however, its safety and efficacy versus OPD remain debatable. METHODS We searched PubMed and Embase. Primary outcomes were the length of hospital stay (LOS) (day), Clavien-Dindo grade ≥III complications, and 90-day mortality. Secondary outcomes were blood loss (milliliter), blood transfusion, duration of operation (minute), readmission, reoperation, comprehensive complication index score, bile leak, gastrojejunostomy or duodenojejunostomy leak, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, surgical site infection, intra-abdominal infection, number of harvested lymph nodes, and R0 resection. Pooled odds ratio (OR) or mean difference (MD) of data was calculated using the random-effect model. The grading of recommendations, assessment, development and evaluation approach was used for grading the level of evidence. RESULTS Four randomized controlled trials yielding 818 patients were included, of which 411 and 407 patients underwent LPD and OPD, respectively. The meta-analysis concluded that 2 approaches were similar, except in the LPD group, the LOS tended to be shorter [MD=-2.54 (-5.17, 0.09), P =0.06], LOS in ICU was shorter [MD=-1 (-1.8, -0.2), P =0.01], duration of operation was longer [MD=75.16 (23.29, 127.03), P =0.005], blood loss was lower [MD=-115.40 (-152.13, -78.68), P <0.00001], blood transfusion was lower [OR=0.66 (0.47, 0.92), P =0.01], and surgical site infection was lower [OR=0.35 (0.12, 0.96), P =0.04]. The overall certainty of the evidence was moderate. CONCLUSIONS Within the hands of highly skilled surgeons in high-volume centers, LPD is feasible and as safe and efficient as OPD.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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13
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Li D, Du C, Wang W, Zhang J, Liu J. First assistant experience in total laparoscopic pancreaticoduodenectomy: accelerating the learning curve for an operator. BMC Surg 2023; 23:92. [PMID: 37069578 PMCID: PMC10111734 DOI: 10.1186/s12893-023-01987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE Compare and analyze clinical data of total laparoscopic pancreaticoduodenectomy (TLPD) cases for surgeons with / without first assistant experience (FAE) in TLPD. Probe influence of FAE in TLPD on the learning curve for an operator. METHODS The clinical data of 239 patients, that underwent TLPD performed by two surgeons between January 2017 and January 2022) in our department, were consecutively collected and divided into two groups (A and B). Group A cases were operated by Surgeon A, with FAE of 57 TLPDs in our department prior to initial TLPD as an operator. Group B cases were operated by Surgeon B with no FAE of TLPD. Cumulative sum (CUSUM) method developed learning curves. Clinical data and both surgeons' learning curves were statistically compared between both groups. RESULTS Between both groups, no statistically significant variations were observed for pre-operative health conditions. Reduced surgical duration, blood loss and transfusion volume during surgery, together with reductions in major post-operative complication rates and reduced hospital/ICU stays were identified within Group A, having statistically significant variations. The technical plateau phases of the learning curves were approximately 25-41 cases and 35-51 cases, for Surgeon A and Surgeon B, respectively. CONCLUSION FAE in TLPD can accelerate the learning curve of TLPD for an operator, with safer surgical procedures and enhanced post-operative recovery.
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Affiliation(s)
- Dongrui Li
- Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Chengxu Du
- Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Wenbin Wang
- Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Jiansheng Zhang
- Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Jianhua Liu
- Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, 050000, Hebei, China.
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14
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Yang Z, Li ZK, Zheng SS. Laparoscopic pancreaticoduodenectomy: From "standard" to "extended". Hepatobiliary Pancreat Dis Int 2023; 22:113-114. [PMID: 36717318 DOI: 10.1016/j.hbpd.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Zhe Yang
- Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Ze-Kuan Li
- Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Shu-Sen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China.
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15
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Wensheg L, Shunrong J, Wenyan X, Yihua S, Mengqi L, Zheng L, Qifeng Z, Xiaowu X, Xianjun Y. Completely 3-dimensional laparoscopic pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: an analysis of 100 consecutive cases. Langenbecks Arch Surg 2023; 408:126. [PMID: 36971912 DOI: 10.1007/s00423-023-02763-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/17/2022] [Indexed: 03/29/2023]
Abstract
PURPOSE Although laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed in high-volume centers, pancreaticojejunostomy (PJ) is still the most challenging procedure. Pancreatic anastomotic leakage remains a major complication after PD. Thus, various technical modifications regarding PJ, such as the Blumgart technique, have been attempted to simplify the procedure and minimize anastomotic leakage. Three-dimensional (3D) laparoscopic systems have been shown to be particularly helpful in performing difficult and precise tasks. We present a modified Blumgart anastomosis in 3D-LPD and investigate its clinical outcomes. METHODS A retrospective analysis of 100 patients who underwent 3D-LPD with modified Blumgart PJ from September 2018 to January 2020 was conducted. Data on the preoperative characteristics, operative outcomes, and postoperative characteristics of the patients were collected and analyzed. RESULTS The mean operative time and duration of PJ were 348.2 and 25.1 min, respectively. The mean estimated blood loss was 112 mL. The overall rate of postoperative complications over Clavien‒Dindo classification III was 18%. The incidence of clinically relevant postoperative pancreatic fistula was 11%. The median postoperative hospital stay was 14.2 days. Only one patient required reoperation (1%), and no patient died in the hospital or 90 days after the operation. High BMI, small main pancreatic duct diameter, and soft pancreatic consistency had a significant influence on the occurrence of CR-POPF. CONCLUSIONS The surgical outcome of 3D-LPD with modified Blumgart PJ seems to be comparable to other studies in terms of operation time, blood loss, hospital stay, and complication incidence. We consider the modified Blumgart technique in 3D-LPD to be novel, reliable, safe, and favorable for PJ in the PD procedure.
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Affiliation(s)
- Liu Wensheg
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
| | - Ji Shunrong
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Xu Wenyan
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Shi Yihua
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Liu Mengqi
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Li Zheng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Zhuo Qifeng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
| | - Xu Xiaowu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
| | - Yu Xianjun
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China.
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
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Sung MK, Song KB, Hong S, Park Y, Kwak BJ, Jun E, Lee W, Lee JH, Hwang DW, Kim SC. Laparoscopic versus open pancreaticoduodenectomy with major vein resection for pancreatic head cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023. [PMID: 36740999 DOI: 10.1002/jhbp.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE Laparoscopic pancreaticoduodenectomy (PD) with major vein resection is a challenging procedure. Herein, we evaluated the feasibility and safety of laparoscopic vein resection in pancreatic head cancer with portal vein/superior mesenteric vein (PV/SMV) invasion, and compared the survival rate following laparoscopic surgery with that following open surgery. METHODS We retrospectively reviewed the electronic medical records of all patients with pancreatic head cancer who underwent surgery performed by a single surgeon from January 2015 to December 2017. Kaplan-Meier curves were plotted to compare the disease-free survival, while Cox-proportional hazard models were used to analyze prognostic factors for survival. RESULTS Among 76 patients, 63 underwent open PD and 13 underwent laparoscopic PD with PV/SMV resection. There was no significant difference in the rate of complications, including portal vein stenosis and portal vein thrombus, recurrence of tumors, or pathological outcomes after surgery between the groups. There was also no significant difference in disease-free survival (p = .803) between the two groups. Additionally, the surgical method was not an independent prognostic factor for disease-free survival. CONCLUSIONS Laparoscopic PD with major vein resection can be feasibly performed in select patients with abutment and focal narrowing of the PV/SMV in pancreatic head cancer.
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Affiliation(s)
- Min Kyu Sung
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sarang Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bong Jun Kwak
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunsung Jun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Lee W, Song KB, Hong S, Park Y, Kwak BJ, Jun E, Hwang DW, Kim S, Lee JH, Kim SC. Minimally invasive versus open pancreaticoduodenectomy for distal bile duct cancer: an inverse probability of treatment weighting analysis of outcomes. Surg Endosc 2023; 37:881-890. [PMID: 36018360 DOI: 10.1007/s00464-022-09533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (MIPD) has been extended to periampullary cancers, but the oncologic outcome of MIPD for distal bile duct cancer (DBDC) has not been confirmed yet. METHODS Patients who underwent pancreaticoduodenectomy (PD) for DBDC of stage I-IIb from 2015 to 2019 at a tertiary referral center were identified and divided into open PD (OPD) and MIPD groups, the latter including laparoscopic and robotic procedures. Survival was compared between the two groups after inverse probability of treatment weighting (IPTW) using predetermined factors, and exploratory mediation analysis was performed using surgery-derived outcomes. RESULTS MIPD (n = 81) group had more female patients (46.9% vs 31.6%, p = 0.011) and longer operation time (366.2 min vs. 279.1 min, p < 0.001) than the OPD (n = 288) group before IPTW. Otherwise, intraoperative and immediate postoperative outcomes were comparable between the two groups. In oncologic outcomes, MIPD group showed comparable 3-year overall survival (78.2% vs 75.0%, p = 0.062) and recurrence-free survival (51.2% vs 53.4%, p = 0.871) rates with OPD group before IPTW, and MIPD was not related with survival (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.29-1.26, p = 0.18) and recurrence (HR 1.01, 95% CI 0.67-1.53, p = 0.949) after IPTW with consideration of potential mediators. Sensitivity analysis using propensity score matching also showed similar results for survival (HR 0.68, 95% CI 0.32-1.44, p = 0.312) and recurrence (HR 1.12, 95% CI 0.67-1.88, p = 0.653). CONCLUSION MIPD and OPD groups showed similar postoperative and oncologic outcomes. MIPD could be a considerable treatment option without oncological compromise in high-volume centers.
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Affiliation(s)
- Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sarang Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Bong Jun Kwak
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Eunsung Jun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Preliminary results of laparoscopic versus open pancreaticoduodenectomy in Vietnam: A retrospective analysis from a multi-center research. Asian J Surg 2023; 46:780-787. [PMID: 35922253 DOI: 10.1016/j.asjsur.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The goal of this study was to compare the results of LPD with those of open pancreaticoduodenectomy (OPD). METHOD Data were retrospectively collected from a database of patients who underwent PD from January 2010 to May 2020. Intraoperative, postoperative, and follow-up assessment studies were conducted. RESULTS A total of 149 patients were selected. Compared with OPD, LPD was fewer intraoperative blood transfusions (p = 0.015), a longer median operative time (p < 0.001), hospital stay (p = 0.034), a higher rate of bile leakage (p = 0.02), overall morbidity (p = 0.045), and re-operation (p = 0.044). There was no difference between the two groups in severe pancreatic fistula, postoperative bleeding, delayed gastric emptying, Clavien-Dindo classification ≥ III, or 30-day mortality. LPD had a similar number of excised lymph nodes, R0 resection rate, and long-term survival cases involving malignant tumors, ampulla of Vater cancer, and pancreatic ductal adenocarcinoma. CONCLUSION In the early period, the benefit of LPD has not been found as there was a high rate of conversion to laparotomy, morbidity, and re-operation. Despite that, LPD is a feasible oncological approach with long-term survival comparable to OPD.
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Zhang B, Xu Z, Gu W, Zhou J, Tang N, Zhang S, Chen C, Zhang Z. Postoperative complications and short-term prognosis of laparoscopic pancreaticoduodenectomy vs. open pancreaticoduodenectomy for treating pancreatic ductal adenocarcinoma: a retrospective cohort study. World J Surg Oncol 2023; 21:26. [PMID: 36710324 PMCID: PMC9885596 DOI: 10.1186/s12957-023-02909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Although laparoscopic pancreaticoduodenectomy (LPD) has been accepted worldwide for treating pancreatic ductal adenocarcinoma (PDA), it is a very technical and challenging procedure. Also, it is unclear whether LPD is superior to open pancreaticoduodenectomy (OPD). This study summarized the experience and efficacy of LPD for treating PDA in our medical center. METHODS This retrospective cohort study included patients with PDA admitted at the Affiliated Hospital of Jiangnan University from October 2019 and January 2021. Patients received either LPD or OPD. Clinical outcomes (operation time, duration of anesthesia, intraoperative hemorrhage), postoperative complications, and short-term outcomes were compared. Cox proportional hazard model and Kaplan-Meier method were used to analyze overall survival (OS) and progression-free survival (PFS). RESULTS Among the PDA patients, 101 patients underwent surgical treatment, 4 patients converted from LPD to OPD, and 7 of them received conservative treatment. Forty-six patients were cured of LPD, and 1 of them died shortly after the operation. Moreover, 44 patients received OPD, and there were 2 postoperative deaths. There were significant differences in the location of the operation time, duration of anesthesia, postoperative hemorrhage, abdominal infections, and postoperative pneumonia between the two groups (all p < 0.05). Multivariate analysis showed that LPD was an independent factor negatively correlated with the incidence of pneumonia (relative risk (RR) = 0.072, 95%CI: 0.016-0.326, p = 0.001) and abdominal infection (RR = 0.182, 95%CI: 0.047-0.709, p = 0.014). Also, there were no differences in OS (hazard ratio (HR) = 1.46, 95%CI: 0.60-3.53, p = 0.40) and PFS (HR = 1.46, 95%CI: 0.64-3.32, p = 0.37) at 12 months between the two groups. CONCLUSIONS LPD could be efficacy and feasible for managing selected PDA patients. Also, LPD has a better effect in reducing postoperative pneumonia and abdominal infection compared to OPD.
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Affiliation(s)
- Bin Zhang
- grid.459328.10000 0004 1758 9149Department of Anesthesiology, The Affiliated Hospital of Jiangnan University, Wuxi, 214122 China
| | - Zipeng Xu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105 China
| | - Weifang Gu
- grid.459328.10000 0004 1758 9149Department of Laboratory, The Affiliated Hospital of Jiangnan University, Wuxi, 214122 China
| | - Junjing Zhou
- grid.459328.10000 0004 1758 9149Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, 214122 China
| | - Neng Tang
- grid.428392.60000 0004 1800 1685Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Shuo Zhang
- grid.428392.60000 0004 1800 1685Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Chaobo Chen
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105 China ,grid.428392.60000 0004 1800 1685Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008 China ,grid.4795.f0000 0001 2157 7667Department of Immunology, Ophthalmology & ORL, Complutense University School of Medicine, 28040 Madrid, Spain
| | - Zhongjun Zhang
- grid.459328.10000 0004 1758 9149Department of Anesthesiology, The Affiliated Hospital of Jiangnan University, Wuxi, 214122 China
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Khuntikeo N, Pugkhem A, Srisuk T, Luvira V, Titapun A, Tipwaratorn T, Thanasukarn V, Klungboonkrong V, Wongwiwatchai J. Surgery. Recent Results Cancer Res 2023; 219:147-222. [PMID: 37660334 DOI: 10.1007/978-3-031-35166-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
This chapter provides a comprehensive background from basic to applied knowledge of surgical anatomy which is necessary for the surgical treatment of cholangiocarcinoma (CCA) patients. Significant advances that have been made in the surgical treatment of CCA were examined. For instance, in-depth details are provided for appropriate preoperative assessment and treatment to optimize patient status and to improve the outcome of surgical treatment(s). Comprehensive details are provided for the surgical techniques and outcomes of treatments for each type of CCA with clear illustrations and images. This chapter also describes the role of minimally invasive surgery and liver transplantation in CCA treatment.
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Affiliation(s)
- Narong Khuntikeo
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Ake Pugkhem
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Tharatip Srisuk
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vor Luvira
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Attapol Titapun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Theerawee Tipwaratorn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vasin Thanasukarn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vivian Klungboonkrong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Jitraporn Wongwiwatchai
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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21
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Zong K, Luo K, Chen K, Ye J, Liu W, Zhai W. A comparative study of robotics and laparoscopic in minimally invasive pancreatoduodenectomy: A single-center experience. Front Oncol 2022; 12:960241. [PMID: 36276160 PMCID: PMC9581246 DOI: 10.3389/fonc.2022.960241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To retrospectively compare the short-term benefits of robotic surgery and laparoscopic in the perioperative period of minimally invasive pancreatoduodenectomy (MIPD). Methods This retrospective analysis evaluated patients who underwent laparoscopic pancreatoduodenectomy (LPD) or robotic pancreatoduodenectomy (RPD) from March 2018 to January 2022 in the First Affiliated Hospital of Zhengzhou University (Zhengzhou, China). Perioperative data, including operating time, complications, morbidity and mortality, estimated blood loss (EBL), and postoperative length of stay, were analysed. Result A total of 190 cases of MIPD were included, of which 114 were LPD and 76 were RPD. There was no significant difference between the two groups in gender, age, previous history of upper abdominal operation, jaundice (>150 µmol/L), or diabetes (P > 0.05). The conversion rate to laparotomy was similar in the LPD and RPD groups (5.3% vs. 6.6%, P = 0.969). A total of 179 cases of minimally invasive pancreatoduodenectomy were successfully performed, including 108 cases of LPD and 71 cases of RPD. There were significant differences between the laparoscopic and robotic groups in operation time [mean, 5.97 h vs. 5.42 h, P < 0.05] and postoperative length of stay [mean, 15.3 vs. 14.6 day, P < 0.05]. No significant difference was observed between the two groups in terms of EBL, intraoperative transfusion, complication rate, mortality rate, or reoperation rate (P > 0.05). There were no significant differences in pathological type, number of lymph nodes harvested, or positive lymph node rate (P > 0.05). Conclusion RPD had an advantage compared to LPD in reduced operation time and postoperative length of stay, technical feasibility, and safety.
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22
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Ma H, Wang J, Liu L, Du Y, Zhao W, Zhu X. Clinical application of pancreatic-duct-jejunum end-to-side continuous suture anastomosis in total laparoscopic pancreaticoduodenectomy. Surg Endosc 2022; 36:5366-5373. [PMID: 34988736 DOI: 10.1007/s00464-021-08920-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To present a new pancreaticojejunostomy technique for laparoscopic pancreaticoduodenectomy (LPD) and to evaluate its safety and reliability. METHODS The data of 120 patients who underwent LPD at a single centre from October 2017 to October 2019 were retrospectively analysed. Of these patients, 71 received continuous suture pancreaticojejunostomy, and 49 received "8-character" suture pancreaticojejunostomy for LPD. We compared and analysed the operation time, anastomosis time, and incidence of postoperative complications between the patients in the two groups. RESULTS All operations were successfully performed, with no transfer to open surgery. The operation time and anastomosis time in the continuous suture group were lower than those in the "8-character" suture group (305.8 ± 60.7 min vs. 354.3 ± 69.1 min; 28.6 ± 6.3 min vs. 39.4 ± 11.9 min P < 0.001), and the postoperative hospital stay was also shorter (12.9 ± 3.8 days vs. 15.4 ± 5.8 days P < 0.05) in the continuous suture group. There was no significant difference in the pancreatic duct diameter or intraoperative blood loss between the two groups. There was also no significant difference in the incidence of a pancreatic fistula between the continuous suture group and the "8-character" suture group. The data of patients in the continuous suture group with pancreatic duct diameters < 3 mm and ≥ 3 mm were statistically analysed. There was no significant difference in the operation time, pancreaticojejunostomy time, postoperative hospital stay, or incidence of pancreatic fistula in the different pancreatic duct diameter groups. CONCLUSIONS Continuous suture of pancreaticojejunostomy in LPD is simple, safe, reliable, and rapid. This technique not only saves the anastomosis time but also suitable for pancreatic ducts < 3 mm.
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Affiliation(s)
- Hongqin Ma
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Ji Wang
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Li Liu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Yusheng Du
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Wenxing Zhao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
| | - Xinguo Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Nakata K, Yamamoto H, Miyata H, Kakeji Y, Kitagawa Y, Nakamura M. Comparison of outcomes between laparoscopic and open pancreaticoduodenectomy without radical lymphadenectomy: Results of coarsened exact matching analysis using national database systems. Asian J Endosc Surg 2022; 15:15-21. [PMID: 33993631 DOI: 10.1111/ases.12948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy has recently been covered under Japan's insurance system for patients not requiring lymph node dissection. Only high-volume hospitals that meet specific criteria are permitted to perform laparoscopic pancreaticoduodenectomy. Although open and laparoscopic pancreaticoduodenectomy outcomes with lymph node dissection have been described previously, procedures performed without lymph node dissection have not been compared using a nationwide database. This study aimed to review the results of laparoscopic pancreaticoduodenectomy and compare them to those of open pancreaticoduodenectomy (OPD) using records from a nationwide database. METHODS We collected patient demographic and medical data of 2900 patients who underwent pancreaticoduodenectomy (laparoscopic, n = 162; open, n = 2738) without lymph node dissection between 2016 and 2018 from the National Clinical Database in Japan. Coarsened exact matching was used to match patients in the laparoscopic and open pancreaticoduodenectomy groups. RESULTS In-hospital mortality was not observed in the laparoscopic pancreaticoduodenectomy group. The rate of conversion to an open procedure was 6.8% (11 cases). After 1:1 matching, we obtained 141 pairs of patients for comparison. The mortality rate was comparable in the laparoscopic and open pancreaticoduodenectomy groups (0.0% vs 0.7%, respectively; P = 1.00). The laparoscopic approach showed more favorable results in terms of median blood loss. Postoperative pancreatic fistula formation and complications were comparable between the two groups. CONCLUSIONS Our results indicate that laparoscopic pancreaticoduodenectomy could be introduced successfully, and the outcomes achieved by the institutions included in our study were comparable to those of open pancreaticoduodenectomy.
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Affiliation(s)
- Kohei Nakata
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Masafumi Nakamura
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Cai H, Feng L, Peng B. Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution. BMC Surg 2021; 21:412. [PMID: 34876071 PMCID: PMC8650331 DOI: 10.1186/s12893-021-01414-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques. METHODS We retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted. RESULTS Totally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3-63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7-24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0-1000.0) vs. 50.0 (20.0-200.0) ml P < 0.001 and 100.0 (20.0-300.0) vs. 50.0 (20.0-200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041). CONCLUSIONS Overall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.
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Affiliation(s)
- He Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China
| | - Lu Feng
- Operating Room of Anesthesia Surgery Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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25
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Comment on "Outcomes After Minimally Invasive Versus Open Pancreatoduodenectomy". Ann Surg 2021; 274:e733. [PMID: 33074879 DOI: 10.1097/sla.0000000000004289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Dembinski J, Yoh T, Aussilhou B, Ftériche FS, Hounkonnou CPA, Hentic O, Cros J, Sauvanet A, Dokmak S. The long-term outcomes of laparoscopic versus open pancreatoduodenectomy for ampullary carcinoma showed similar survival: a case-matched comparative study. Surg Endosc 2021; 36:4732-4740. [PMID: 34724575 DOI: 10.1007/s00464-021-08813-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few studies have compared the oncological benefit of laparoscopic (LPD) and open pancreatoduodenectomy (OPD) for ampullary carcinoma. The aim of this study was to compare the oncological results of these two approaches. METHODS Between 2011 and 2020, 103 patients who underwent PD for ampullary carcinoma, including 31 LPD and 72 OPD, were retrospectively analyzed. Patients were matched on a 1:2 basis for age, sex, body mass index, American Society of Anaesthesiologists score, and preoperative biliary drainage. Short- and long-term outcomes of LPD and OPD were compared. RESULTS The 31 LPD were matched (1:2) to 62 OPD. LPD was associated with a shorter operative time (298 vs. 341 min, p = 0.02) than OPD and similar blood loss (361 vs. 341 mL, p = 0.747), but with more intra- and post-operative transfusions (29 vs. 8%, p = 0.008). There was no significant difference in postoperative mortality (6 vs. 2%), grades B/C postoperative pancreatic fistula (22 vs. 21%), delayed gastric emptying (23 vs. 35%), bleeding (22 vs. 11%), Clavien ≥ III morbidity (22 vs. 19%), or the length of hospital stay (26 vs. 21 days) between LPD and OPD, respectively, but there were more reinterventions (22 vs. 5%, p = 0.009). Pathological characteristics were similar for tumor size (21 vs. 22 mm), well differentiated tumors (41 vs. 38%), the number of harvested (23 vs. 26) or invaded lymph nodes (48 vs. 52%), R0 resection (84 vs. 90%), and other subtypes (T1/2, T3/4, phenotype). With a comparable mean follow-up (41 vs. 37 months, p = 0.59), there was no difference in 1-, 3-, and 5-year overall (p = 0.725) or recurrence-free survival (p = 0.155) which were (93, 74, 67% vs. 97, 79, 76%) and (85, 58, 58% vs. 90, 73, 73%), respectively. CONCLUSION This study showed a similar long-term oncological results between LPD and OPD for ampullary carcinoma. However, the higher morbidity observed with LPD compared to OPD, restricting its use to experienced centers.
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Affiliation(s)
- Jeanne Dembinski
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Tomoaki Yoh
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.,Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan
| | - Béatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Fadhel Samir Ftériche
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Cornélia P A Hounkonnou
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Hôpital Bichat-Claude Bernard, University of Paris, Paris, France.,Institut National de La Santé et de la Recherche Médicale (INSERM), Hôpital Bichat-Claude Bernard, CIC-EC 1425, Paris, France.,Department of Biostatic and Clinical Research, DMU AP-HP, Hôpital Bichat, PRISME, Paris, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Jérome Cros
- Department of Pathology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Alain Sauvanet
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.
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Hwang HK, Song KB, Park M, Kwon W, Jang JY, Heo JS, Choi DW, Kang CM, Park JS, Hong TH, Cho CK, Ahn KS, Lee H, Lee SE, Jeong CY, Roh YH, Kim HJ, Hwang DW, Kim SC, Han HS, Yoon YS. Minimally Invasive Versus Open Pancreatectomy for Right-Sided and Left-Sided G1/G2 Nonfunctioning Pancreatic Neuroendocrine Tumors: A Multicenter Matched Analysis with an Inverse Probability of Treatment-Weighting Method. Ann Surg Oncol 2021; 28:7742-7758. [PMID: 33969463 DOI: 10.1245/s10434-021-10092-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Limited evidence exists for the safety and oncologic efficacy of minimally invasive surgery (MIS) for nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) according to tumor location. This study aimed to compare the surgical outcomes of MIS and open surgery (OS) for right- or left-sided NF-PNETs. METHODS The study collected data on patients who underwent surgical resection (pancreatoduodenectomy, distal/total/central pancreatectomy, duodenum-preserving pancreas head resection, or enucleation) of a localized NF-PNET between January 2000 and July 2017 at 14 institutions. The inverse probability of treatment-weighting method with propensity scores was used for analysis. RESULTS The study enrolled 859 patients: 478 OS and 381 MIS patients. A matched analysis by tumor location showed no differences in resection margin, intraoperative blood loss, or complications between MIS and OS. However, MIS was associated with a longer operation time for right-sided tumors (393.3 vs 316.7 min; P < 0.001) and a shorter postoperative hospital stay for left-sided tumors (8.9 vs 12.9 days; P < 0.01). The MIS group was associated with significantly higher survival rates than the OS group for right- and left-sided tumors, but survival did not differ for the patients divided by tumor grade and location. Multivariable analysis showed that MIS did not affect survival for any tumor location. CONCLUSION The short-term outcomes offered by MIS were comparable with those of OS except for a longer operation time for right-sided NF-PNETs. The oncologic outcomes were not compromised by MIS regardless of tumor location or grade. These findings suggest that MIS can be performed safely for selected patients with localized NF-PNETs.
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Affiliation(s)
- Ho Kyoung Hwang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Minsu Park
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Choi
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Moo Kang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seong Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Ho Hong
- Department of Hepatobiliary and Pancreas Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chol Kyoon Cho
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Korea
| | - Keun Soo Ahn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Huisong Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Hoon Roh
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Hee Joon Kim
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
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Nassour I, Paniccia A, Moser AJ, Zureikat AH. Minimally Invasive Techniques for Pancreatic Resection. Surg Oncol Clin N Am 2021; 30:747-758. [PMID: 34511194 DOI: 10.1016/j.soc.2021.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is increasing interest in the role of minimally invasive surgery (MIS) for pancreatectomy. Prospective data indicate significant advantages for MIS when performed for left-sided pancreatic pathologies and may be deemed as the standard of care. However, there is reluctance in implementing this technique to pancreaticoduodenectomy because of the complexity of the operation and the mixed results from randomized trials. A detailed description of the technical aspects of robotic pancreaticoduodenectomy and distal pancreatectomy is presented in this article in addition to a summary of the most important prospective and cohort studies. We also provide insights into patient selection and the learning curve of MIS surgery for pancreatectomy.
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Affiliation(s)
- Ibrahim Nassour
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - A James Moser
- Harvard Medical School, Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Center Avenue, Suite 421, Pittsburgh, PA 15232, USA.
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Efficacy of laparoscopic-assisted pancreaticoduodenectomy in Vietnamese patients with periampullary of Vater malignancies: A single-institution prospective study. Ann Med Surg (Lond) 2021; 69:102742. [PMID: 34504691 PMCID: PMC8417344 DOI: 10.1016/j.amsu.2021.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Minimally invasive pancreaticoduodenectomy is a technically complex technique, that is being used to treat periampullary malignancy. We provide our experience with laparoscopic-assisted pancreaticoduodenectomy (LAPD) with statistics on the outcomes of periampullary cancer patients. Material and method Thirty patients underwent surgery between June 1, 2016 and May 30, 2020, with 21 undergoing classical PD and 9 undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). Prospectively gathered data on surgical outcomes and long-term oncological results are given. Results The median operative time was 277.5 min (range, 258.7–330 min), and the median intraoperative estimated blood loss was 319.5 mL (range, 241.2–425 mL). The rate of conversion to OPD, surgical reintervention, and mortality was 20%, 13.3%, and 10% respectively. Cumulative surgery-related morbidity was 33.4%, including bleeding (n = 4), severe POPF (n = 4), biliary fistula (n = 1), DGE (n = 2), and intestinal obstruction (n = 1). Pathologic diagnoses were AoV cancer (n = 23), distal CBD cancer (n = 4), PDAC (n = 2), and AoV NET (n = 1). The mean survival time of the LAPD group was 29.9 months. The long-term survival time of the N0 group was 36.8 months, which was significantly longer than that of the N1 group. The long-term survival times of stages I–B, II-A, and II-B were 36.9, 26.5, and 15.7 months, respectively (p = 0.016). Conclusion LAPD has a high rate of conversion to OPD, morbidity, and mortality. However, LPD is feasible technique for highly selected patients. Lymph node metastasis and stage of disease are the risk factors for long-term survival. Most of tumours that develop in the periampullary of the Vater region are malignant. Laparoscopic pancreaticoduodenectomy (LPD) remains the most challenging procedure in laparoscopic surgery with the rate of conversion to OPD, morbility, and mortality was 0–40%, 3.8%–50%, and 1.6%–8%, respectively. In the first 30 cases, LAPD has a high rate of complications, conversion to OPD, and mortality. However, LAPD is feasible method and can provide acceptable oncological results with careful patient selection. Experience, learning curve, and high-volume centre might have influenced the results.
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Park MY, Lee W, Kwon J, Song KB, Hwang DW, Lee JH, Kim SC. Comparison of perioperative outcomes in pancreatic head cancer patients following either a laparoscopic or open pancreaticoduodenectomy with a superior mesenteric artery first approach. Ann Hepatobiliary Pancreat Surg 2021; 25:358-365. [PMID: 34402436 PMCID: PMC8382868 DOI: 10.14701/ahbps.2021.25.3.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Backgrounds/Aims A superior mesenteric artery first approach (SFA) technique can improve the complete resection rate. It can be used to determine whether an operation can be performed by invading the superior mesenteric artery before performing a pancreatic transection in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to compare perioperative outcomes between laparoscopic and open SFA for PDAC. Methods Between January 2017 and August 2019, consecutive patients who underwent laparoscopic and open pancreaticoduodenectomy (PD) for PDAC using SFA procedures were included and compared between laparoscopic and open procedures. Results Fourteen and 83 patients underwent laparoscopic and open surgeries, respectively. In perioperative outcomes, there were no significant differences in the amount of intraoperative blood loss or transfusion rate between the two groups. In the laparoscopic group, the operation time was longer with less patients showing wound infection. R0 resection rate and the number of retrieved lymph nodes showed no significant difference. The average time to adjuvant chemotherapy was longer in the open group. There was no significant difference in the mean survival time or the recurrence free period. Conclusions Patients who underwent laparoscopic PD using SFA showed perioperative outcomes comparable compared to those of patients who underwent open procedures performed by experienced surgeons.
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Affiliation(s)
- Min Young Park
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woohyung Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewoo Kwon
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hung TM, Son TQ, Hoc TH, Tung TT, Truong TV, Cuong LM, Kien VD. Long- and short-term survival following laparoscopic and open pancreaticoduodenectomy for patients with periampullary tumors in Vietnam. Ann Med Surg (Lond) 2021; 69:102690. [PMID: 34429954 PMCID: PMC8365319 DOI: 10.1016/j.amsu.2021.102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Laparoscopic pancreaticoduodenectomy (LPD) is a less invasive alternative to the traditional open pancreaticoduodenectomy (OPD) approach used to treat periampullary tumors. However, previous studies examining the advantages of this surgery over OPD have produced mixed results. Here, a retrospective observational approach was used to compare the short- and long-term outcomes of patients with periampullary tumors who underwent LPD or OPD at a single institution in Vietnam. Materials and methods Data were obtained from hospital medical records collected over five years from patients that underwent OPD or LPD. Information on demographics, medical status, tumor characteristics, operative variables, complications, and mortality was examined. Survival curves were constructed and the stepwise multivariate Cox proportional hazard model was used to identify the factors associated with the risk of death following surgery. Results Eighty-four patients aged 26–80 years were included. Twenty-two patients underwent LPD and 62 received OPD. The operative time for the LPD group was significantly longer than that for the OPD group, and the LPD group was less likely to require a blood transfusion during surgery. While the short- and long-term survival rates did not differ for the procedures, the factors associated with the risk of death following surgery were tumors at the N1 stage and an age >65 years. Conclusion Both LPD and OPD procedures for treating periampullary tumors exhibited comparable safety profiles, with similar short-term outcomes and long-term survival rates observed. Future studies with a larger sample size should be conducted to further examine the treatment outcomes following these surgical approaches. The OPD group was significantly more likely to require blood transfusion as compared to the LPD group (p=0.04). The operative time for the LPD group was significantly longer than that for the OPD group (p < 0.01). Factors associated with the risk of death following surgery were tumors at the N1 stage and age group > 65 years.
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Affiliation(s)
- Tran Manh Hung
- Department of General Surgery, Bach Mai Hospital, No. 78 Giai Phong Street, Hanoi, Viet Nam
| | - Tran Que Son
- Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, Viet Nam
| | - Tran Hieu Hoc
- Hanoi Medical University, No. 1 Ton That Tung Street, Hanoi, Viet Nam
| | - Tran Thanh Tung
- Department of General Surgery, Bach Mai Hospital, No. 78 Giai Phong Street, Hanoi, Viet Nam
| | - Trieu Van Truong
- Department of General Surgery, Bach Mai Hospital, No. 78 Giai Phong Street, Hanoi, Viet Nam
| | - Le Manh Cuong
- National Hospital of Traditional Medicine, No. 29 Nguyen Binh Khiem Street, Hanoi, Viet Nam
| | - Vu Duy Kien
- OnCare Medical Technology Company Limited, No. 77/508 Lang Street, Hanoi, Viet Nam
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Kim H, Choi HZ, Kang BM, Lee JW. Learning Curve in Laparoscopic Pancreaticoduodenectomy: Using Risk-Adjusted Cumulative Summation Methods. J Laparoendosc Adv Surg Tech A 2021; 32:401-407. [PMID: 34388041 DOI: 10.1089/lap.2021.0260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Laparoscopic pancreaticoduodenectomy (LPD) is one of the most technically challenging operations of minimally invasive surgery. We aimed to analyze the learning curve of a single surgeon who conducted 115 LPDs at a single center. Materials and Methods: From August 2015 to August 2020, 115 patients underwent LPD. Patient characteristics and perioperative variables were retrospectively collected and analyzed. Cumulative summation (CUSUM) and risk-adjusted cumulative summation (RA-CUSUM) analyses were used to evaluate the LPD learning curve. All variables were compared after dividing the learning curve phases. Results: After 74 cases, operative time improved based on the CUSUM analysis of the operation time. From the RA-CUSUM analysis, three distinct phases of the learning curve were identified (phase I: 1-42 cases, phase II: 43-73 cases, and phase III: 74-115 cases). The mean operative time was significantly lower in phase III compared with that in phases I and II (348.5 minutes versus 444.6 minutes and 439.9 minutes, P < .001 and P < .001, respectively). The rate of estimated blood loss >500 mL was significantly decreased among the three phases (P = .017). The conversion rate significantly decreased from 11.9% in phase I to 6.5% in phase II to 0% in phase III (P = .023). The rates of overall complication (Clavien-Dindo >IIIA), postoperative pancreatic fistula, and postpancreatectomy hemorrhage were significantly decreased as phases progressed. Postoperative hospital stay, 30-day mortality, and 30-day readmission did not significantly differ among phases. Conclusions: According to learning curve analyses, the LPD failure rate plateaued after 42 cases and stabilized after 73 cases.
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Affiliation(s)
- Hanbaro Kim
- Department of Surgery, Hallym University College of Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Han Zo Choi
- Department of Emergency Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Gangdong-gu, South Korea
| | - Byung Mo Kang
- Department of Surgery, Hallym University College of Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Jung Woo Lee
- Department of Surgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
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Tang YC, Liu QQ, He YG, Li J, Huang XB. Laparoscopic pancreaticoduodenectomy: a retrospective study of 200 cases and the optimization of the single-center learning curve. Transl Cancer Res 2021; 10:3436-3447. [PMID: 35116648 PMCID: PMC8798474 DOI: 10.21037/tcr-21-518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022]
Abstract
Background Laparoscopic pancreaticoduodenectomy (LPD) is widely used in several centers. This study analyzed the postoperative complications rate curve, possible cause, and solution of LPD and open pancreaticoduodenectomy (OPD). Methods Between January 2015 and December 2019, the study included 213 and 204 patients undergoing OPD and LPD, respectively. Postoperative outcomes, complications, and complication risk, along with operation time were analyzed, and the learning curve was determined. Results The OPD group (378.7±8.98 min) had shorter operation time than the LPD group (402.5±7.12 min) (P=0.037). Blood loss was significantly lower in the LPD group (389.9±19.05 mL) than in the OPD group (530.1±33.55 mL) (P<0.001). The incidence of biliary-enteric anastomosis leakage was higher in the LPD group (2.9%) than in the OPD group (0.5%) (P=0.0495). The LPD group showed lower lung infection (7.4% vs. 17.4%, P=0.037), incision infection (1% vs. 8.5%, P<0.001), and anal exhaust time (3.35±0.07 vs. 4.05±0.07 days, P<0.001) than the OPD group. The biliary-enteric anastomosis leakage was strongly correlated with the pancreatic fistula (B/C) (R=0.6410), intraperitoneal infection (R=0.6126) and Clavien-Dindo Classification ≥3 (R=0.7403). According to the cumulative sum (CUSUM) curve, pancreatic fistula had a negative K value in 44 cases, biliary-enteric anastomosis leakage had a negative K value in 46 cases, and Clavien-Dindo Classification ≥3 had a negative K value in 40 cases. The learning curve for LPD has an inflection point in 86 cases. Conclusions LPD is safe and effective for patients with pancreatic cancer, and has a long learning curve and improved postoperative complications in 50 cases. This study’s results will help in reducing the complication rates of the first 50 consecutive cases of LPD.
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Affiliation(s)
- Yi-Chen Tang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Qin-Qin Liu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yong-Gang He
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jing Li
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiao-Bing Huang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
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Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 2021; 6:438-447. [PMID: 33915091 DOI: 10.1016/s2468-1253(21)00054-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The benefit and safety of laparoscopic pancreatoduodenectomy (LPD) for the treatment of pancreatic or periampullary tumours remain controversial. Studies have shown that the learning curve plays an important role in LPD, yet there are no randomised studies on LPD after the surgeons have surmounted the learning curve. The aim of this trial was to compare the outcomes of open pancreatoduodenectomy (OPD) with those of LPD, when performed by experienced surgeons. METHODS In this multicentre, open-label, randomised controlled trial done in 14 Chinese medical centres, we recruited patients aged 18-75 years with a benign, premalignant, or malignant indication for pancreatoduodenectomy. Eligible patients were randomly assigned (1:1) to undergo either LPD or OPD. Randomisation was centralised via a computer-generated system that used a block size of four. The patients and surgeons were unmasked to study group, whereas the data collectors, outcome assessors, and data analysts were masked. LPD and OPD were performed by experienced surgeons who had already done at least 104 LPD operations. The primary outcome was the postoperative length of stay. The criteria for discharge were based on functional recovery, and analyses were done on a modified intention-to-treat basis (ie, including patients who had a pancreatoduodenectomy regardless of whether the operation was the one they were assigned to). This trial is registered with Clinicaltrials.gov, number NCT03138213. FINDINGS Between May 18, 2018, and Dec 19, 2019, we assessed 762 patients for eligibility, of whom 656 were randomly assigned to either the LPD group (n=328) or the OPD group (n=328). 31 patients in each group were excluded and 80 patients crossed over (33 from LPD to OPD, 47 from OPD to LPD). In the modified intention-to-treat analysis (297 patients in the LPD group and 297 patients in the OPD group), the postoperative length of stay was significantly shorter for patients in the LPD group than for patients in the OPD group (median 15·0 days [95% CI 14·0-16·0] vs 16·0 days [15·0-17·0]; p=0·02). 90-day mortality was similar in both groups (five [2%] of 297 patients in the LPD group vs six [2%] of 297 in the OPD group, risk ratio [RR] 0·83 [95% CI 0·26-2·70]; p=0·76). The incidence rate of serious postoperative morbidities (Clavien-Dindo grade of at least 3) was not significantly different in the two groups (85 [29%] of 297 patients in the LPD group vs 69 [23%] of 297 patients in OPD group, RR 1·23 [95% CI 0·94-1·62]; p=0·13). The comprehensive complication index score was not significantly different between the two groups (median score 8·7 [IQR 0·0-26·2] vs 0·0 [0·0-20·9]; p=0·06). INTERPRETATION In highly experienced hands, LPD is a safe and feasible procedure. It was associated with a shorter length of stay and similar short-term morbidity and mortality rates to OPD. Nonetheless, the clinical benefit of LPD compared with OPD was marginal despite extensive procedural expertise. Future research should focus on identifying the populations that will benefit from LPD. FUNDING National Natural Science Foundation of China and Tongji Hospital, Huazhong University of Science and Technology, China.
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Dokmak S, Aussilhou B, Ftériche FS, Dembinski J, Romdhani C, Sauvanet A. The outcome of laparoscopic pancreatoduodenectomy is improved with patient selection and the learning curve. Surg Endosc 2021; 36:2070-2080. [PMID: 33881625 DOI: 10.1007/s00464-021-08493-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In our first experience, laparoscopic pancreatoduodenectomy (LPD) was associated with higher morbidity than open PD. Since, the surgical technique has been improved and LPD was avoided in some patients at very high risk of postoperative pancreatic fistula (POPF). We provide our most recent results. METHOD Between 2011 and 2018, 130 LPD were performed and divided into 3 consecutive periods based on CUSUM analysis and compared: first period (n = 43), second period (n = 43), and third period (n = 44). RESULTS In the third period of this study, LPD was more frequently performed in women (46%, 39%, 59%, p = 0.21) on dilated Wirsung duct > 3 mm (40%, 44%, 57%; p = 0.54). Intraductal papillary mucinous neoplasm (IPMN) became the primary indication (12%, 39%, 34%; p = 0.037) compared to pancreatic adenocarcinoma (35%, 16%, 16%; p = 0.004). Malignant ampulloma re-increased during the third period (30%, 9%, 20%; p = 0.052) with the amelioration of surgical technique. The operative time increased during the second period and decreased during the third period (330, 345, 270; p < 0.001) with less blood loss (300, 200, 125; p < 0.001). All complications decreased, including POPF grades B/C (44%, 28%, 20%; p = 0.017), bleeding (28%, 21%, 14%; p = 0.26), Clavien-Dindo III-IV (40%, 33%, 16%; p = 0.013), re-interventions (19%, 14%, 9%; p = 0.43), and the hospital stay (26, 19, 18; p = 0.045). Less patients with similar-sized adenocarcinoma were operated during the second period (70%, 33%, 59%; p = 0.002) with more harvested lymph nodes in the third period (21,19, 25; p = 0.031) and higher R0 resection (70%, 79%, 84%; p = 0.5). On multivariate analysis the protective factors against POPF of grades B/C were pancreatic adenocarcinoma and invasive IPMN, BMI < 22.5 kg/m2, and patients operated in the third period. CONCLUSION This study showed that the outcome of LPD significantly improves with the learning curve and patient selection. For safe implementation and during the early learning period, LPD should be indicated in patients at lower risk of POPF.
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Affiliation(s)
- Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
| | - Béatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Fadhel Samir Ftériche
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Jeanne Dembinski
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Chihebeddine Romdhani
- Department of Anesthesiology and Intensive Care Medicine, Military Hospital of Tunis, Tunis, Tunisia
| | - Alain Sauvanet
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
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Tyutyunnik P, Klompmaker S, Lombardo C, Lapshyn H, Menonna F, Napoli N, Wellner U, Izrailov R, Baychorov M, Besselink MG, Abu Hilal M, Fingerhut A, Boggi U, Keck T, Khatkov I. Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy. Surg Endosc 2021; 36:1515-1526. [PMID: 33825015 DOI: 10.1007/s00464-021-08439-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION There are limited numbers of high-volume centers performing minimally invasive pancreatoduodenectomy (MIPD) routinely. Several approaches to MIPD have been described. Aim of this analysis was to show the learning curve of three different approaches to MIPD. Focus was on determining the number of cases necessary to obtain proficient level in MIPD. PATIENTS AND METHODS Retrospective study wherein outcomes of 300 consecutive patients at three centers-at each center the initial 100 consecutive patients undergoing MIPD for malignant and benign tumors of the head of the pancreas and perimpullary area, performed by three experienced surgeons were collected and analyzed. RESULTS Overall, 300 patients after MIPD were included: the three different cohorts (laparoscopic n = 100, hybrid n = 100, robotic n = 100). CUSUM analysis of operating time in each center demonstrated that the plateau for laparoscopic PD was n = 61, for hybrid PDes was n = 32 and for robotic PD was n = 68. Median operative time for laparoscopic, hybrid, and robotic approaches was 395 min, 404 min, 510 min, respectively. Intraoperative blood loss for laparoscopic PD, hybrid PD, and robotic PD was 250 ml, 250 ml, and 413 ml, respectively. Delayed gastric emptying occurred 12% in laparoscopic cohort, 10% in hybrid, and 53% in robotic cohort. Major complications (Clavien-Dindo III/IV) rate for laparoscopic PD, hybrid PD, and robotic PD was 32%, 37%, and 22% with 5% death in each cohorts, respectively. CONCLUSION This analysis of the learning curve of three European centers found a shorter learning curve with hybrid PD as compared to laparoscopic and robotic PD. In implementation of a MIPD program, a stepwise approach might be beneficial.
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Affiliation(s)
- Pavel Tyutyunnik
- Department of High-Tech and Endoscopic Surgery, Moscow Clinical Scientific Center Named After A.C.Loginov, Entusiastov shosse, 86, Moscow, Russia, 111123. .,Chair of Faculty Surgery No.2, FSBEI HE A.I. Yevdokimov MSMSU MOH, Moscow, Russia.
| | - Sjors Klompmaker
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carlo Lombardo
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | | | - Francesca Menonna
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | - Niccolò Napoli
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | - Ulrich Wellner
- Department of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - Roman Izrailov
- Department of High-Tech and Endoscopic Surgery, Moscow Clinical Scientific Center Named After A.C.Loginov, Entusiastov shosse, 86, Moscow, Russia, 111123.,Chair of Faculty Surgery No.2, FSBEI HE A.I. Yevdokimov MSMSU MOH, Moscow, Russia
| | - Magomet Baychorov
- Department of High-Tech and Endoscopic Surgery, Moscow Clinical Scientific Center Named After A.C.Loginov, Entusiastov shosse, 86, Moscow, Russia, 111123
| | - Mark G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Moh'd Abu Hilal
- Chair of the Department of Surgery, Head of Hepatobiliary Pancreatic and Minimally Invasive Surgery, Poliambulanza Foundation Hospital, Via Bissolati, Brescia, Italy
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.,Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ugo Boggi
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | - Tobias Keck
- Department of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - Igor Khatkov
- Department of High-Tech and Endoscopic Surgery, Moscow Clinical Scientific Center Named After A.C.Loginov, Entusiastov shosse, 86, Moscow, Russia, 111123.,Chair of Faculty Surgery No.2, FSBEI HE A.I. Yevdokimov MSMSU MOH, Moscow, Russia
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Post-operative procalcitonin and C-reactive protein predict pancreatic fistula after laparoscopic pancreatoduodenectomy. BMC Surg 2021; 21:171. [PMID: 33784995 PMCID: PMC8008693 DOI: 10.1186/s12893-021-01177-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background Clinically relevant pancreatic fistula (CRPF) is a serious complication following laparoscopic pancreaticoduodenectomy (LPD). This study aimed to determine if C-reactive protein (CRP) and procalcitonin (PCT) serum levels could be used as early biomarkers to predict CRPF after LPD. Methods In this retrospective study, we collected peri-operative data of patients who underwent LPD between January 2019 and November 2019. We compared serum levels of white blood cells (WBC), CRP, and PCT on post-operative days (POD) 1, 2, 3, 5, and 7 between the CRPF and non-CRPF groups and analyzed the predictive risk factors for CRPF. Results Among the 186 patients included in this study, 18 patients (9.7%) developed CRPF, including 15 and 3 patients with grade B and C fistulas, respectively. The mean WBC, CRP, and PCT levels were higher on most PODs in the CRPF group compared to the non-CRPF group. Receiver operating characteristic (ROC) analysis indicated that CRP levels on POD 2, 5, and 7 can predict CRPF development after LPD, with the area under the curve (AUC) value reaching the highest level on POD 2 (AUC 0.794). PCT levels on POD 2, 3, 5, and 7 were highly predictive of CRPF after LPD. The highest AUC value was achieved on POD 3 [PCT > 2.10 ng/ml (AUC 0.951; sensitivity 88.2%, specificity 92.9%, P < 0.001)]. Conclusions Both CRP and PCT levels can be used to predict CRPF development after LPD, with PCT having a higher predictive value.
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Wu J, Xiang Y, You G, Liu Z, Lin R, Yao X, Yang Y. An essential technique for modern hepato-pancreato-biliary surgery: minimally invasive biliary reconstruction. Expert Rev Gastroenterol Hepatol 2021; 15:243-254. [PMID: 33356656 DOI: 10.1080/17474124.2021.1847081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Minimally invasive reconstruction of the biliary tract is complex and involves multiple steps. The procedure is challenging and has been an essential technique in modern hepato-pancreato-biliary surgery in recent years. Additionally, the quality of the reconstruction directly affects long-and short-term complications and affects the prognosis and quality of life. Various minimally invasive reconstruction methods have been developed to improve the reconstruction effect; however, the optimal method remains controversial. Areas covered: In this study, were viewed published studies of minimally invasive biliary reconstruction within the last 5 years and discussed the current status and main complications of minimally invasive biliary reconstruction. More importantly, we introduced the current reconstruction strategies and technical details of minimally invasive biliary reconstruction, which may be potentially helpful for surgeons to choose reconstruction methods and improve reconstruction quality. Expert opinion: Although several improved and modified methods for biliary reconstruction have been developed recently, no single approach is optimal or adaptable to all situations. Patient-specific selection of appropriate technical strategies according to different situations combined with sophisticated and skilled minimally invasive techniques effectively improves the quality of anastomosis and reduces complications.
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Affiliation(s)
- Jiacheng Wu
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , Changchun, China
| | - Yien Xiang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , Changchun, China
| | - Guangqiang You
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China
| | - Zefeng Liu
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China
| | - Ruixin Lin
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China
| | - Xiaoxiao Yao
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China
| | - Yongsheng Yang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , Changchun, China
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Ding W, Wu W, Tan Y, Chen X, Duan Y, Sun D, Lu Y, Xu X. The comparation of short-term outcome between laparoscopic and open pancreaticoduodenectomy: a propensity score matching analysis. Updates Surg 2021; 73:419-427. [PMID: 33590350 DOI: 10.1007/s13304-021-00997-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/04/2021] [Indexed: 12/12/2022]
Abstract
Pancreaticoduodenectomy (PD) is one of the most complex and delicate operations in abdominal surgery. With the development of laparoscopic techniques, more and more pancreatic experts have become skilled in laparoscopic pancreaticoduodenectomy (LPD). However, the short-term efficacy of LPD compared to open pancreaticoduodenectomy (OPD) remains unclear. Here, we performed a propensity score matching study aiming to compare the short outcomes of patients who underwent LPD or OPD after the learning curve and established a risk model of pancreatic fistula. The data of 346 patients who had OPD or LPD from July 2015 to January 2020 were retrieved. After a 1:1 matching, 224 patients remained. The operation time was significantly longer (P = 0.001) but the amount of bleeding was significantly lower (P = 0.001) in the LPD group than in the OPD group. Patients in LPD group had fewer blood transfusions (P = 0.002) than those in OPD group. More lymph nodes (P < 0.001) were dissected in LPD group. The rate of grade B/C pancreatic fistula was significantly higher in the LPD group than in the OPD group (16.1% vs. 6.3%, P = 0.002). By multi variate Logistic regression analysis, we identified pancreatic tumor, malignancy and low body mass index were risk factors of Grade B/C pancreatic fistula after PD operation. Then, we developed a Grade B/C pancreatic fistula nomogram with the risk factors. The C-index of the nomogram was 0.836 (95% CI 0.762-0.910). In conclusion, LPD could be technically feasible, get less trauma and achieve similar short-term outcome as compared with OPD.
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Affiliation(s)
- Wei Ding
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, #185 Juqian Road, Changzhou, 213003, China
- Department of General Surgery, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213017, China
- Department of General Surgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, China
| | - Wenze Wu
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, #185 Juqian Road, Changzhou, 213003, China
- Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Yulin Tan
- Department of General Surgery, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213017, China
- Department of General Surgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, China
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, #185 Juqian Road, Changzhou, 213003, China
| | - Yunfei Duan
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, #185 Juqian Road, Changzhou, 213003, China
| | - Donglin Sun
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, #185 Juqian Road, Changzhou, 213003, China.
| | - Yunjie Lu
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, #185 Juqian Road, Changzhou, 213003, China.
| | - Xuezhong Xu
- Department of General Surgery, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213017, China.
- Department of General Surgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, China.
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Chan KS, Wang ZK, Syn N, Goh BKP. Learning curve of laparoscopic and robotic pancreas resections: a systematic review. Surgery 2021; 170:194-206. [PMID: 33541746 DOI: 10.1016/j.surg.2020.11.046] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Minimally invasive pancreatic resection has been shown recently in some randomized trials to be superior in selected perioperative outcomes compared with open resection when performed by experienced surgeons. However, minimally invasive pancreatic resection is associated with a long learning curve. This study aims to summarize the current evidence on the learning curve of minimally invasive pancreatic resection and define the number of cases required to surmount the learning curve. METHODS A systematic search was performed on PubMed, Embase, Scopus, and the Cochrane database using a detailed search strategy. Studies that did not describe the learning curve were excluded from the study. Data on the method of learning curve analysis, single surgeon versus institutional learning curve, and outcome measures were extracted and analyzed. RESULTS A total of 32 studies were included in the pooled analysis: 12 on laparoscopic pancreatoduodenectomy, 9 on robotic pancreatoduodenectomy, 12 on laparoscopic distal pancreatectomy, and 3 on robotic distal pancreatectomy. Sample population was comparable between laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy (median 63 vs 65). Six of 12 studies and 7 of 9 studies used nonarbitrary methods of analysis in laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy, respectively. Operating time was used as the single outcome measure in 4 of 12 studies in laparoscopic pancreatoduodenectomy and 5 of 9 studies in robotic pancreatoduodenectomy. Overall, there was no significant difference between the number of cases required to surmount the learning curve for laparoscopic pancreatoduodenectomy versus robotic pancreatoduodenectomy (laparoscopic pancreatoduodenectomy 34.1 [95% confidence interval 30.7-37.7] versus robotic pancreatoduodenectomy 36.7 [95% confidence interval 32.9-41.0]; P = .8241) and laparoscopic distal pancreatectomy versus robotic distal pancreatectomy (laparoscopic distal pancreatectomy 25.3 [95% confidence interval 22.5-28.3] versus robotic distal pancreatectomy 20.7 [95% confidence interval 15.8-26.5]; P = .5997.) CONCLUSION: This study provides a detailed summary of existing evidence around the learning curve in minimally invasive pancreatic resection. There was no significant difference between the learning curve for robotic pancreatoduodenectomy versus laparoscopic pancreatoduodenectomy and robotic distal pancreatectomy versus laparoscopic distal pancreatectomy. These findings were limited by the retrospective nature and heterogeneity of the studies published to date.
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Affiliation(s)
- Kai Siang Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Lee Kong Chian Medical School, Nanyang Technological University, Singapore
| | - Zhong Kai Wang
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Lee Kong Chian Medical School, Nanyang Technological University, Singapore; Duke-National University of Singapore Medical School, Singapore.
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Hong SS, Chong JU, Hwang HK, Lee WJ, Kang CM. Laparoscopic pancreaticoduodenectomy reduces incidence of clinically relevant postoperative pancreatic fistula in soft pancreas with a smaller than 2 mm pancreatic duct. Surg Endosc 2021; 35:7094-7103. [PMID: 33398573 DOI: 10.1007/s00464-020-08226-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Soft pancreas with small pancreatic duct is a known risk factor for postoperative pancreatic fistula (POPF). This study demonstrated the safety and feasibility of laparoscopic duct-to-mucosa pancreaticojejunostomy (PJ) and compared perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with soft pancreas and small pancreatic duct. METHODS From January 2014 to December 2019, 183 patients underwent LPD and 91 patients underwent OPD by a single surgeon. Data on patients with soft pancreas and combined small pancreatic duct (≤ 2 mm) were retrospectively reviewed. Clinicopathologic characteristics, and perioperative outcomes were compared between LPD and OPD. We evaluated risk factors affecting clinically relevant POPF (CR-POPF). We also correlated calculated risks of POPF and CR-POPF between the two groups. RESULTS We compared 62 patients in the LPD group and 34 patients in the OPD group. Perioperative outcomes showed less blood loss, shorter hospital stays, and less postoperative pain score on postoperative day (POD)#1 and #5 in LPD compared with OPD. Postoperative complications showed no differences between LPD and OPD. LPD group showed significantly reduced CR-POPF rates compared to the OPD group (LPD 11.3% vs. OPD 29.4%, p = 0.026). Multivariate analysis identified obesity (BMI ≥ 25), thick pancreas parenchyma and open surgery as independent predicting factors for CR-POPF. The LPD group showed less CR-POPF than the OPD group according to POPF risk groups. This difference was more prominent in a high-risk group. CONCLUSION With appropriate laparoscopic technique, LPD is feasible and safe and reduces CR-POPF in soft pancreas with a small pancreatic duct.
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Affiliation(s)
- Seung Soo Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Ku, Seoul, 03722, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Jae Uk Chong
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Ku, Seoul, 03722, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Ku, Seoul, 03722, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Ku, Seoul, 03722, Korea.
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.
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Goh BK, Low TY, Teo JY, Lee SY, Chan CY, Chow PK, Chung AY, Ooi LPJ. Adoption of Robotic Liver, Pancreatic and Biliary Surgery in Singapore: A Single Institution Experience with Its First 100 Consecutive Cases. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020; 49:742-748. [DOI: 10.47102/annals-acadmedsg.202036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Introduction: Presently, robotic hepatopancreatobiliary surgery (RHPBS) is increasingly adopted worldwide. This study reports our experience with the first 100 consecutive cases of RHPBS in Singapore. Methods: Retrospective review of a single-institution prospective database of the first 100 consecutive RHPBS performed over 6 years from February 2013 to February 2019. Eighty-six cases were performed by a single surgeon. Results: The 100 consecutive cases included 24 isolated liver resections, 48 pancreatic surgeries (including 2 bile duct resections) and 28 biliary surgeries (including 8 with concomitant liver resections). They included 10 major hepatectomies, 15 pancreaticoduodenectomies, 6 radical resections for gallbladder carcinoma and 8 hepaticojejunostomies. The median operation time was 383 minutes, with interquartile range (IQR) of 258 minutes and there were 2 open conversions. The median blood loss was 200ml (IQR 350ml) and 15 patients required intra-operative blood transfusion. There were no post-operative 90-day nor in-hospital mortalities but 5 patients experienced major (> grade 3a) morbidities. The median post-operative stay was 6 days (IQR 5 days) and there were 12 post-operative 30-day readmissions. Comparison between the first 50 and the subsequent 50 patients demonstrated a significant reduction in blood loss, significantly lower proportion of malignant indications, and a decreasing frequency in liver resections performed. Conclusion: Our experience with the first 100 consecutive cases of RHPBS confirms its feasibility and safety when performed by experienced laparoscopic hepatopancreatobiliary surgeons. It can be performed for even highly complicated major hepatopancreatobiliary surgery with a low open conversion rate. Keywords: Biliary surgery, hepaticojejunostomy, liver resection, pancreas, pancreaticoduodenectomy
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Affiliation(s)
| | | | | | | | | | | | | | - LPJ Ooi
- Singapore General Hospital, Singapore
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Jingdong L, Yongfu X, Yang G, Jian X, Xujian H, Jianhua L, Wenxing Z, Renyi Q, Xinming Y, Shuguo Z, Xiao L, Bin P, Qifan Z, Dewei L, Zhao-Hui T. Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients. Surg Endosc 2020; 35:6612-6622. [PMID: 33258033 DOI: 10.1007/s00464-020-08161-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Curative resection of hilar cholangiocarcinoma (HC) is typically carried out using open surgery. In the present study, we examined the safety (postoperative complication) and effectiveness (resection margin status and patient survival) of minimally invasive surgery (MIS) for HC. METHODS This retrospective analysis included 158 patients receiving MIS for HC at 10 participating centers between December 2013 and November 2019. Patient demographics, surgical outcomes, and oncological outcomes were retrospectively analyzed. RESULTS Clinical information obtained from 10 different clinical centers did not show any evident cohort-bias clustering. One hundred and twenty-six (79.7%) patients underwent LRHC, 12 (7.6%) patients underwent RARHC, conversion to an open procedure occurred in 20 (12.7%) patients. The operation time and estimated blood loss were 410.8 ± 128.9 min and 477.8 ± 706.3 mL, respectively. The surgical radicality of the 158 patients was R0, 129 (81.6%); R1, 20 (18.4%) and R2, 9 (5.7%). Grades I-II complications was occurred in 68 (43.0%) patients. Severe morbidity (grade III-V) occurred in 14 (8.7%) patients. The median overall survival in whole cohort was 25.4 months. The overall survival rate was 67.6% at year 1, 28.8% at year 3, and 19.2% at year 5. Comparing the first half of MISHC performed by each center with the following cases, the operation time and postoperative hospital stay does not decrease with the increasing cases. On literature review, MISHC is non-inferior to open surgery at least in perioperative period. CONCLUSIONS In this Chinese MIS for HC multicenter study, the largest to date, long-term overall survival rates after MIS appear comparable to those reported in current open series. Further randomized controlled trials are necessary to assess the global impact of MISHC.
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Affiliation(s)
- Li Jingdong
- Department of General Surgery, Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, No.63 Wenhua Road, Shunqing District, Nanchong, 637000, China.
| | - Xiong Yongfu
- Department of General Surgery, Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, No.63 Wenhua Road, Shunqing District, Nanchong, 637000, China.
| | - Gang Yang
- Department of General Surgery, Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, No.63 Wenhua Road, Shunqing District, Nanchong, 637000, China
| | - Xu Jian
- Department of General Surgery, Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, No.63 Wenhua Road, Shunqing District, Nanchong, 637000, China
| | - Huang Xujian
- Department of General Surgery, Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, No.63 Wenhua Road, Shunqing District, Nanchong, 637000, China
| | - Liu Jianhua
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Hebei Medical University, Hebei, 200092, China
| | - Zhao Wenxing
- Department of Hepatobiliary Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, China
| | - Qin Renyi
- Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yin Xinming
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha, 410005, China
| | - Zheng Shuguo
- Department of Biliary Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China
| | - Liang Xiao
- Department of Hepatobiliary Surgery, SirRunRunShaw Hospital of Zhejiang University, Hangzhou, 310020, China
| | - Peng Bin
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zhang Qifan
- Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Li Dewei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Tang Zhao-Hui
- Department of General Surgery, Xinhua Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Yangpu District, No.1665 Kong jiang Road, Shanghai, 200000, China.
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Lin R, Lin X, Lu F, Yang Y, Wang C, Fang H, Wen S, Chen Y, Huang H. Combination of anterior superior mesenteric vein-first and right posterior superior mesenteric artery-first approaches for uncinate process dissection in minimally invasive pancreaticoduodenectomy. Gland Surg 2020; 9:1396-1405. [PMID: 33224815 DOI: 10.21037/gs-20-228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Uncinate process dissection is a key step in minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic and robotic procedures, which increase the intraoperative blood loss and operative time and decrease the R0 resection rate if improperly handled. However, few studies have reported the operative skills in detail. Methods We performed uncinate process dissection using a combination of the anterior superior mesenteric vein (SMV)-first approach and the right posterior superior mesenteric artery (SMA)-first approach in MIPD for 138 patients with periampullary tumors between March 2017 and October 2019. The demographic and perioperative data of all the patients were collected to evaluate the efficacy of this method. Results All patients underwent an uneventful operation. An assistant incision was performed to separate extensive adhesion between the tumor and the SMV in 3 patients. The combined approach had a notably shorter operation time and resection time, less intraoperative blood loss and a shorter postoperative hospital stay than the traditional approach (P<0.05). There were no significant differences in conversion rate, numbers of harvested lymph node or postoperative complications, including postoperative pancreatic fistula, bile leakage, delayed gastric emptying, postoperative bleeding and reoperation between the two groups (P>0.05). There were no deaths during the perioperative period. Conclusions The combination of the anterior SMV-first approach and the right posterior SMA-first approach is a safe and feasible technique for uncinate process dissection in MIPD.
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Affiliation(s)
- Ronggui Lin
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xianchao Lin
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fengchun Lu
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuanyuan Yang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Congfei Wang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Haizong Fang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shi Wen
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanchang Chen
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Heguang Huang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma? Cancers (Basel) 2020; 12:cancers12113430. [PMID: 33218187 PMCID: PMC7699219 DOI: 10.3390/cancers12113430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Pancreatic cancer is known to be one of the most lethal malignant diseases in gastrointestinal tract. Margin-negative pancreatectomy followed by postoperative adjuvant chemotherapy is essential treatment for long-term survival. Due to anatomical complexity and technical difficulty, laparoscopic pancreaticoduodenectomy is still controversial. However, with the advance of laparoscopic surgery, laparoscopic pancreatic resection of pancreatic head cancer has been carefully applied in well selected patients. The accumulating data are suggesting its technical feasibility, safety, and potential equivalent long-term oncologic outcome. In this review, the current status of laparoscopic pancreaticoduodenectomy for pancreatic head cancer is summarized. In addition, potential surgical indications and future perspectives of laparoscopic pancreaticoduodenectomy for pancreatic cancer are discussed for safe implementation in our clinical practice. Abstract Margin-negative radical pancreatectomy is the essential condition to obtain long-term survival of patients with pancreatic cancer. With the investigation for early diagnosis, introduction of potent chemotherapeutic agents, application of neoadjuvnat chemotherapy, advancement of open and laparoscopic surgical techniques, mature perioperative management, and patients’ improved general conditions, survival of the resected pancreatic cancer is expected to be further improved. According to the literatures, laparoscopic pancreaticoduodenectomy (LPD) is also thought to be good alternative strategy in managing well-selected resectable pancreatic cancer. LPD with combined vascular resection is also feasible, but only expert surgeons should handle these challenging cases. LPD for pancreatic cancer should be determined based on surgeons’ proficiency to fulfil the goals of the patient’s safety and oncologic principles.
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The Effect of Age on Short- and Long-Term Outcomes in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Laparoscopic Pancreaticoduodenectomy. Pancreas 2020; 49:1063-1068. [PMID: 32769853 DOI: 10.1097/mpa.0000000000001620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effect of age on outcomes with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic pancreaticoduodenectomy (LPD). METHODS We retrospectively collected clinical data of consecutive patients with PDAC undergoing LPD from January 2012 to April 2019. The patients were divided into 2 groups according to age at admission for LPD: younger than 70 and 70 years or older. RESULTS A total of 147 patients were included (<70 years, n = 96; ≥70 years, n = 51). The elderly LPD patients had lower serum albumin levels (mean, 37.9 [standard deviation, 4.8] g/L vs 40.7 [standard deviation, 6.8] g/L, P = 0.004) and a larger frequency of comorbidities (62.7% vs 36.5%, P = 0.002) than younger patients. The short-term outcomes showed no significant differences. The median overall survival time of the younger patients was not significantly greater than that of the elderly patients (20.0 [95% confidence interval, 16.1-23.9] months vs 19.0 [95% confidence interval, 13.8-24.2] months, P = 0.902). CONCLUSIONS The short- and long-term outcomes of elderly patients with PDAC after LPD were similar to those of younger patients, despite a higher prevalence of multiple chronic illnesses and poorer nutritional conditioning among the elderly patients. These results show that LPD can be applied safely to elderly patients.
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Qin R, Kendrick ML, Wolfgang CL, Edil BH, Palanivelu C, Parks RW, Yang Y, He J, Zhang T, Mou Y, Yu X, Peng B, Senthilnathan P, Han HS, Lee JH, Unno M, Damink SWMO, Bansal VK, Chow P, Cheung TT, Choi N, Tien YW, Wang C, Fok M, Cai X, Zou S, Peng S, Zhao Y. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobiliary Surg Nutr 2020; 9:464-483. [PMID: 32832497 PMCID: PMC7423539 DOI: 10.21037/hbsn-20-446] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/15/2020] [Indexed: 02/05/2023]
Abstract
IMPORTANCE While laparoscopic pancreaticoduodenectomy (LPD) is being adopted with increasing enthusiasm worldwide, it is still challenging for both technical and anatomical reasons. Currently, there is no consensus on the technical standards for LPD. OBJECTIVE The aim of this consensus statement is to guide the continued safe progression and adoption of LPD. EVIDENCE REVIEW An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy. Statements were produced upon reviewing the literature and assessed by the members of the expert panel. The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019. The Web of Science, Medline, and Cochrane Library and Clinical Trials databases were searched, The search strategy included, but was not limited to, the terms 'laparoscopic', 'pancreaticoduodenectomy, 'pancreatoduodenectomy', 'Whipple's operation', and 'minimally invasive surgery'. Reference lists from the included articles were manually checked for any additional studies, which were included when appropriate. Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements. The statements were further discussed during a one-day face-to-face meeting at the 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan, China. FINDINGS Twenty-eight international experts from 8 countries constructed the expert panel. Sixteen statements were produced by the members of the expert panel. At least 80% of responders agreed with the majority (80%) of statements. Other than three randomized controlled trials published to date, most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument. CONCLUSIONS AND RELEVANCE The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD. LPD is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.
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Affiliation(s)
- Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Christopher L. Wolfgang
- Division of Surgical Oncology, Department of Surgery, The John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barish H. Edil
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Chinnusamy Palanivelu
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Rowan W. Parks
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Jin He
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiping Mou
- Department of Gastroenterology and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Palanisamy Senthilnathan
- Department of Surgical Gastroenterology and Hepatopancreatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Steven W. M. Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Pierce Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Nim Choi
- Department of General Surgery, Hospital Conde S. Januário, Macau, China
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Manson Fok
- Department of Surgery, University Hospital, Macau University of Science and Technology, Macau, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Shengquan Zou
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyou Peng
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center. Wideochir Inne Tech Maloinwazyjne 2020; 16:62-75. [PMID: 33786118 PMCID: PMC7991938 DOI: 10.5114/wiitm.2020.97363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/14/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction The landscape of surgical treatments for hepatobiliary disease was significantly changed after the advent of laparoscopy. Many kinds of complex laparoscopic procedures can be routinely performed at present, but radical resection of hilar cholangiocarcinoma (HC) by laparoscopy is still highly contentious. Aim To describe our primary experience with laparoscopic radical resection for HC and determine the safety and feasibility of this procedure. Material and methods Between December 2015 and November 2019, 32 patients planned to undergo curative-intent laparoscopic resection of HC in our department. The perioperative and long-term outcomes of these patients were retrospectively analyzed. Results Laparoscopic surgery with radical resection was ultimately performed in 24 (75.0%) patients; 3 (9.3%) patients were found to be unresectable at the preliminary exploration stage, and 5 (15.7%) patients converted from laparoscopy to laparotomy. The operation time and blood loss were 476.95 ±133.89 min and 568.75 ±324.01 ml, respectively. A negative margin was achieved in 19 (79.1%) of the laparoscopy patients. Three (12.5%) patients were identified with microscopic positive margins, and 2 (8.4%) patients underwent macroscopic residual tumor resection (R2). The length of postoperative stay was 23.3 ±11.7 days. Severe morbidity occurred in 4 (16.6%) patients. The actuarial 3-year overall survival and disease-free survival for patients who underwent laparoscopic surgery were 49.1% and 47.0%, respectively. Conclusions Laparoscopic radical resection for HC is safe and feasible in experienced hands for highly selected patients but is still in its initial stages. When adequate oncologic resection is performed, the laparoscopic approach does not adversely influence the prognosis of the patient.
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Wu J, Zhang G, Yao X, Xiang Y, Lin R, Yang Y, Zhang X. Achilles'heel of laparoscopic pancreatectomy: reconstruction of the remnant pancreas. Expert Rev Gastroenterol Hepatol 2020; 14:527-537. [PMID: 32567383 DOI: 10.1080/17474124.2020.1775582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Laparoscopic pancreatic reconstruction is a challenging procedure and is considered the Achilles' heel of laparoscopic pancreatectomy. Multiple techniques of laparoscopic pancreatic reconstruction have been reported, but the optimal technique remains unclear. AREAS COVERED This paper provides a brief introduction to the developmental status and major related complications of laparoscopic pancreatic reconstruction. We reviewed all published literature on the technology of laparoscopic pancreatic reconstruction within the last 5 years and herein discuss the advantages and disadvantages of different reconstruction methods. We also discuss several details of different reconstruction techniques in terms of their significance to the operation and complications. EXPERT OPINION No individual method of laparoscopic pancreatic reconstruction is considered optimal for all conditions. The reconstruction strategy should be based on the surgeon's proficiency with laparoscopic technology and the patient's individual risk factors. Personalized methods of pancreatic reconstruction may more effectively reduce morbidity and mortality.
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Affiliation(s)
- Jiacheng Wu
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , 130041, Changchun, China, East Asia
| | - Guofeng Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Xiaoxiao Yao
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Yien Xiang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , 130041, Changchun, China, East Asia
| | - Ruixin Lin
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Yongsheng Yang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia
| | - Xuewen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University , 130041, Changchun, China, East Asia.,Jilin Engineering Laboratory for Translational Medicine of Hepatobiliary and Pancreatic Diseases , 130041, Changchun, China, East Asia
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50
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Goh BKP, Teo RY. Current Status of Laparoscopic and Robotic Pancreatic Surgery and Its
Adoption in Singapore. ANNALS ACADEMY OF MEDICINE SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.202063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite the potential clinical advantages offered by laparoscopic pancreatic surgery (LPS), the main obstacle to its widespread adoption is the technically demanding nature of the procedure and its steep learning curve. LPS and robotic pancreatic surgery (RPS) have been proven to result in superior short-term perioperative outcomes and equivalent long-term oncological outcomes compared to the conventional open approach, with the caveat that they are performed by expert surgeons who have been trained to perform such procedures. The primary challenge faced by most pancreatic surgeons is the steep learning curve associated with these complex procedures and the need to undergo surgical training, especially with regards to laparoscopic and robotic pancreaticoduodenectomy. Current evidence suggests that RPS may help to shorten the lengthy learning curve required for LPS. More robust evidence—in the form of large randomised controlled trials—is needed to determine whether LPS and RPS can be safely adopted universally.
Ann Acad Med Singapore 2020;49:377–83
Key words: Laparoscopic pancreatectomy, Laparoscopic pancreaticoduodenectomy, Minimally invasive pancreatic surgery, Robotic pancreatectomy, Robotic pancreaticoduodenectomy
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