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Anand U, Kodali R, Parasar K, Singh BN, Kant K, Yadav S, Anwar S, Arora A. Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis. Ann Hepatobiliary Pancreat Surg 2024; 28:220-228. [PMID: 38384237 PMCID: PMC11128788 DOI: 10.14701/ahbps.23-144] [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: 11/07/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Backgrounds/Aims Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD). Methods A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared. Results The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, p = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups. Conclusions LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.
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Affiliation(s)
- Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Rohith Kodali
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Kunal Parasar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Basant Narayan Singh
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Kislay Kant
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Sitaram Yadav
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Saad Anwar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Abhishek Arora
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India
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Nguyen HH, Nguyen TK, Trinh HS, Do HD, Luong TH, Pham HM, Le VD, Do VM, Chantha P, Pham HQ, Nguyen DV. Feasibility of middle colic artery as a landmark for superior mesenteric artery - first approach in laparoscopic pancreatoduodenectomy: a prospective study. World J Surg Oncol 2024; 22:141. [PMID: 38802849 PMCID: PMC11131284 DOI: 10.1186/s12957-024-03416-3] [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: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND SMA-first approach in pancreatoduodenectomy (PD) has been widely applied in open surgery as well as laparoscopy. Finding the superior mesenteric artery (SMA), inferior pancreatoduodenal artery (IPDA), first jejunal artery (J1A) has become a great challenge in laparoscopic PD (LPD). Meanwhile, exposing the midde colic artery (MCA) might be a feasible approach to determine SMA, IPDA, and J1A. Our study aims to find the anatomical correlation between MCA and SMA, IPDA, J1A, especially in SMA-first approach LPD from the left. METHODS Uncontrolled clinical trial with 33 patients undergoing LPD had preoperative contrast abdominal CT scan to analyze the anatomical relevance between MCA and SMA, J1A, IPDA. The operation was performed starting with exposing MCA in advance to find SMA, J1A and IPDA. The data was analyzed by SPSS 25.0. RESULTS 90.9% of MCA started at 12-3 o'clock from SMA, the mean distance from the SMA root to the MCA and J1A was 56.4 mm and 37.4 mm, respectively. The distance between SMA and J1A was 19 mm. 72.7% J1A started at 9-12 o'clock, 69.7% J1A and IPDA had a common trunk. 78.8% IPDA started at 3-6 o'clock. 100% of the cases had J1A controlled intraoperatively, 81.8% for IPDA when approached from the left, 3% had MCA injury. The mean time to approach from the left was 98 min, median blood loss was 100 ml. CONCLUSION Exposing MCA first helps determine SMA, J1A and IPDA safely, efficiently and faciliates SMA-first approach LPD from the left and complete dissection of the mesopancreas and lymph nodes.
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Affiliation(s)
- Ham Hoi Nguyen
- Hanoi Medical University, Hanoi, Vietnam
- Center of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Thanh Khiem Nguyen
- Center of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
| | - Hong Son Trinh
- Deparment of Oncology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Hai Dang Do
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Center of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Van Duy Le
- Center of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Van Minh Do
- Center of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Hong Quang Pham
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
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Liu C, Liu Y, Dong J, Chai Y, Tang H. Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for carcinoma of the ampulla of Vater in a medium-volume center: a propensity score matching analysis. J Int Med Res 2023; 51:3000605231219061. [PMID: 38150553 PMCID: PMC10754028 DOI: 10.1177/03000605231219061] [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: 05/10/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To compare the efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in a medium-volume medical center. METHODS Data for patients who underwent OPD or LPD for carcinoma of the ampulla of Vater (VPC) between January 2017 and June 2022 were acquired retrospectively. Propensity score-matching (PSM) analysis was performed to balance the baseline characteristics between the groups. The primary outcome was disease-free survival (DFS). Cox regression analysis was used to explore the independent risk factors for DFS. RESULTS A total of 124 patients with pathologically diagnosed VPC were included. After 1:1 matching, there were 23 cases each in the OPD and LPD groups. Kaplan-Meier survival analyses showed that the median DFS in the OPD and LPD groups was identical (16.0 months vs 16.0 months, respectively). Multivariate Cox regression analysis showed that low levels of alkaline phosphatase and γ-glutamyl transpeptidase, positive surgical margin, and lymph node enlargement were independent risk factors for DFS. CONCLUSION LPD in medium-volume centers with acceptable technical conditions may approach or even achieve the efficacy of LPD in large-volume centers.
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Affiliation(s)
- Chenming Liu
- Department of Hepatobiliary and Pancreatic Surgery, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yuxing Liu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Colorectal and Anal Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, China
| | - Jiaming Dong
- Department of Hepatobiliary and Pancreatic Surgery, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, China
| | - Yingjie Chai
- Department of Hepatobiliary Surgery, Haining People’s Hospital, Jiaxing, Zhejiang Province, China
| | - Haijun Tang
- Department of Hepatobiliary and Pancreatic Surgery, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, China
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Rousek M, Whitley A, Kachlík D, Balko J, Záruba P, Belbl M, Nikov A, Ryska M, Gürlich R, Pohnán R. The dorsal pancreatic artery: A meta-analysis with clinical correlations. Pancreatology 2022; 22:325-332. [PMID: 35177332 DOI: 10.1016/j.pan.2022.02.002] [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: 01/03/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The dorsal pancreatic artery is the main artery of the body and tail of the pancreas. Its origin and branching is highly variable. The aim of this study was to perform a meta-analysis to generate pooled prevalence data on the presence and origin of the dorsal pancreatic artery. Clinically important aspects of the dorsal pancreatic artery were summarised during the literature review. METHODS Major medical databases were searched. Data on the presence and point of origin of the dorsal pancreatic artery were extracted and quantitatively synthesised. The obtained data of anatomical based studies and computed tomography based studies were statistically analysed. RESULTS In total, 30 studies, comprising 2322 anatomical and computed tomography based cases were included. The dorsal pancreatic artery was present in 95.8% of cases. It originated from the splenic artery in 37.6% of cases, common hepatic artery in 18.3% of cases, coeliac trunk in 11.9% of cases and the superior mesenteric artery in 23.9% of cases. Other rare origins were present in 2.77% of cases. Multiple dorsal pancreatic arteries were found in 1,7% of cases. There was no significant difference in the presence or origin of the dorsal pancreatic artery between anatomical and computed tomography based studies. CONCLUSION The dorsal pancreatic artery is present in the vast majority of cases. Its origin and branching are highly variable. Multiplicity of the dorsal pancreatic artery is infrequent.
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Affiliation(s)
- Michael Rousek
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic.
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University Prague and Faculty Hospital Motol, Czech Republic
| | - Pavel Záruba
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic
| | - Miroslav Belbl
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrej Nikov
- Department of Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miroslav Ryska
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic
| | - Robert Gürlich
- Department of Surgery, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radek Pohnán
- Department of Surgery, Second Faculty of Medicine of Charles University and Military University Hospital, Prague, Czech Republic
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