Clinical analysis of 51 cases of total laparoscopic pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Pengbo , REN Zeqiang , ZHANG Chong , GONG Shuai , ZHANG Yi , WU Nai ,  ZHANG Xiuzhong

Department of Pancreatic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P. R. China;

Corresponding author：

ZHANG Xiuzhong, Email: 13776780677@163.com

Keywords：

pancreaticoduodenectomy; laparoscope; complication; prognosis

DOI：

10.7507/1007-9424.201903032

Video：

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Objective To evaluate clinical feasibility and safety of total laparoscopic pancreaticoduodenectomy (TLPD).Method The clinical data of 51 consecutive cases who underwent TLPD, admitted in this department of pancreatic surgery of the Affiliated Hospital of Xuzhou Medical University from August 2016 to August 2018, were analyzed retrospectively.Results The TLPDs were successfully completed in the 51 patients. The operative time was (375.5±75.2) min, the pancreaticojejunostomy time was (45.2±8.3) min and bilioenteric anastomosis time was (25.6±7.5) min. The intraoperative blood loss was (337.8±164.4) mL. The length of surgical incision was (6.0±1.2) cm. The duration of flatulence was (3.5±1.0) d. The time for liquid diet was (5.2±2.1) d, the postoperative first ambulation time was (2.0±1.2) d. The duration of postoperative hospital stay was (14.8±5.3) d. The total postoperative complication rate was 34.3% (17/51), with 19.6% (10/51) of B or C postoperative pancreatic fistula and 9.8% (5/51) of bleeding. The postoperative pathology showed that there were 45 cases of malignant tumor and there was no positive incisal margin. The maximum tumor size was (2.8±1.2) cm and the number of lymph nodes harvested was 12.6±7.8. All the patients were followed up for 2–24 months with a median time of 17 months. The 1-year overall survival rate and progression-free survival rate of the patients with malignant tumors were 84.4% (38/45) and 77.8% (35/45), respectively.Conclusion TLPD is safe and feasible in cases of clinical practice under skilled hand and there are advantages such as faster postoperative recovery and shorter hospital stay.

Citation： ZHANG Pengbo, REN Zeqiang, ZHANG Chong, GONG Shuai, ZHANG Yi, WU Nai, ZHANG Xiuzhong. Clinical analysis of 51 cases of total laparoscopic pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 818-822. doi: 10.7507/1007-9424.201903032 Copy

1.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
2.	Gagner M, Pomp A. Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg, 1997, 1(1): 20-25.
3.	中华医学会外科学分会胰腺外科学组, 中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组, 中国研究型医院学会胰腺疾病专业委员会胰腺微创学组, 等. 腹腔镜胰十二指肠切除手术专家共识 (附: 手术流程与主要步骤). 中华外科杂志, 2017, 55(5): 335-339.
4.	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识 (2017). 中华外科杂志, 2017, 55(5): 328-334.
5.	Khatkov I, Izrailov R, Tyutyunnik P, et al. One hundred and forty five total laparoscopic pancreatoduodenectomies: A single centre experience. Pancreatology, 2017, 17(6): 936-942.
6.	Zhang H, Guo X, Xia J, et al. Comparison of totally 3-dimensional laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Pancreas, 2018, 47(5): 592-600.
7.	Torphy RJ, Friedman C, Halpern A, et al. Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers. Ann Surg, 2018 May 16. doi: 10.1097/SLA.0000000000002810.
8.	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
9.	Palanivelu C, Senthilnathan P, Sabnis SC, et al. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg, 2017, 104(11): 1443-1450.
10.	蒋康怡, 高峰畏, 雷泽华, 等. 全腹腔镜与开腹胰十二指肠切除术比较的非 RCT 研究的 meta 分析. 中国普外基础与临床杂志, 2019, 26(4): 448-457.
11.	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
12.	Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-559.
13.	Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc, 2013, 27(1): 95-103.
14.	陈思瑞, 蔡云强, 彭兵. 腹腔镜胰十二指肠切除术的术后并发症处理经验. 中国普外基础与临床杂志, 2017, 24(7): 819-824.
15.	Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg, 2015, 19(1): 189-194.
16.	Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: a retrospective multicenter analysis of 1 029 patients. Ann Surg, 2019 Jan 17. doi: 10.1097/SLA.0000000000003190.
17.	Lee CS, Kim EY, You YK, et al. Perioperative outcomes of laparoscopic pancreaticoduodenectomy for benign and borderline malignant periampullary disease compared to open pancreaticoduodenectomy. Langenbecks Arch Surg, 2018, 403(5): 591-597.
18.	Conrad C, Basso V, Passot G, et al. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc, 2017, 31(10): 3970-3978.
19.	Kantor O, Talamonti MS, Sharpe S, et al. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg, 2017, 213(3): 512-515.
20.	Peng L, Zhou Z, Cao Z, et al. Long-term oncological outcomes in laparoscopic versus open pancreaticoduodenectomy for pancreatic cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2019 Mar 5. doi: 10.1089/lap.2018.0683.
21.	Chapman BC, Gajdos C, Hosokawa P, et al. Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc, 2018, 32(5): 2239-2248.
22.	王文斌, 闫长青, 吕海涛, 等. 腹腔镜与开腹胰十二指肠切除术疗效分析. 中华肝胆外科杂志, 2017, 23(2): 110-113.
23.	金继宽, 熊光冰, 朱峰, 等. 腹腔镜与开腹胰十二指肠切除术治疗胰头癌的近期疗效分析. 中华消化外科杂志, 2018, 17(7): 718-723.
24.	段小辉, 毛先海, 蒋波, 等. 腹腔镜胰十二指肠切除术治疗远端胆管癌的临床疗效. 中华消化外科杂志, 2018, 17(3): 304-309.

1. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
2. Gagner M, Pomp A. Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg, 1997, 1(1): 20-25.
3. 中华医学会外科学分会胰腺外科学组, 中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组, 中国研究型医院学会胰腺疾病专业委员会胰腺微创学组, 等. 腹腔镜胰十二指肠切除手术专家共识 (附: 手术流程与主要步骤). 中华外科杂志, 2017, 55(5): 335-339.
4. 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识 (2017). 中华外科杂志, 2017, 55(5): 328-334.
5. Khatkov I, Izrailov R, Tyutyunnik P, et al. One hundred and forty five total laparoscopic pancreatoduodenectomies: A single centre experience. Pancreatology, 2017, 17(6): 936-942.
6. Zhang H, Guo X, Xia J, et al. Comparison of totally 3-dimensional laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Pancreas, 2018, 47(5): 592-600.
7. Torphy RJ, Friedman C, Halpern A, et al. Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers. Ann Surg, 2018 May 16. doi: 10.1097/SLA.0000000000002810.
8. Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
9. Palanivelu C, Senthilnathan P, Sabnis SC, et al. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg, 2017, 104(11): 1443-1450.
10. 蒋康怡, 高峰畏, 雷泽华, 等. 全腹腔镜与开腹胰十二指肠切除术比较的非 RCT 研究的 meta 分析. 中国普外基础与临床杂志, 2019, 26(4): 448-457.
11. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
12. Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-559.
13. Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc, 2013, 27(1): 95-103.
14. 陈思瑞, 蔡云强, 彭兵. 腹腔镜胰十二指肠切除术的术后并发症处理经验. 中国普外基础与临床杂志, 2017, 24(7): 819-824.
15. Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg, 2015, 19(1): 189-194.
16. Wang M, Peng B, Liu J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: a retrospective multicenter analysis of 1 029 patients. Ann Surg, 2019 Jan 17. doi: 10.1097/SLA.0000000000003190.
17. Lee CS, Kim EY, You YK, et al. Perioperative outcomes of laparoscopic pancreaticoduodenectomy for benign and borderline malignant periampullary disease compared to open pancreaticoduodenectomy. Langenbecks Arch Surg, 2018, 403(5): 591-597.
18. Conrad C, Basso V, Passot G, et al. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc, 2017, 31(10): 3970-3978.
19. Kantor O, Talamonti MS, Sharpe S, et al. Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg, 2017, 213(3): 512-515.
20. Peng L, Zhou Z, Cao Z, et al. Long-term oncological outcomes in laparoscopic versus open pancreaticoduodenectomy for pancreatic cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2019 Mar 5. doi: 10.1089/lap.2018.0683.
21. Chapman BC, Gajdos C, Hosokawa P, et al. Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc, 2018, 32(5): 2239-2248.
22. 王文斌, 闫长青, 吕海涛, 等. 腹腔镜与开腹胰十二指肠切除术疗效分析. 中华肝胆外科杂志, 2017, 23(2): 110-113.
23. 金继宽, 熊光冰, 朱峰, 等. 腹腔镜与开腹胰十二指肠切除术治疗胰头癌的近期疗效分析. 中华消化外科杂志, 2018, 17(7): 718-723.
24. 段小辉, 毛先海, 蒋波, 等. 腹腔镜胰十二指肠切除术治疗远端胆管癌的临床疗效. 中华消化外科杂志, 2018, 17(3): 304-309.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical analysis of 51 cases of total laparoscopic pancreaticoduodenectomy

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