Back to Annual Meeting Program

Background: Although feasibility of total laparoscopic pancreatoduodenectomy (TLPD) has been established, a large scale study comparing the invasiveness of TLPD with open pancreatoduodenectomy (OPD) has never reported.
Purpose: The purpose of this study was to investigate if TLPD can reduce the postoperative incidence of systemic inflammatory response syndrome (SIRS) compared with OPD.
Methods: A single-institutional retrospective cohort study of all pancreaticoduodenectomy patients between 2007 and 2010 was performed. The incidence of SIRS was measured three times a day (at the nearest point of 8, 16 and 24 o’clock) from postoperative day (POD) 1 to POD 5. The incidence of SIRS on each POD was defined by meeting the criteria of SIRS at two or more points out of the daily three measurement points. Perioperative outcomes including the incidence of SIRS were compared between TLPD and OPD group. The relationship between the clinicopathological factors and the incidence of postoperative SIRS was investigated using univariate and multivariate analyses.
Results: Five hundred twenty-seven consecutive patients (TLPD n = 125, OPD n = 402) were included in study. Six patients (5%) with conversion to OPD were included in TLPD group based on intent-to-treat. The reasons for conversion were the possibility of major venous resection (n = 3), bleeding (n = 1), severe adhesion (n = 1) and expected difficult reconstruction (n = 1). Compared with patients in the OPD group, those in the TLPD group had significantly less preoperative clinical jaundice (42% vs. 53%, P = 0.03), less adenocarcinoma (58% vs. 70%, P = 0.01), and smaller pancreatic duct size (3.7mm vs. 4.2mm, P = 0.002). Median estimated blood loss was less for the TLPD group than the OPD group (200ml vs. 600ml, P < 0.001). However, there were no differences in postoperative complication (62% vs. 67%, P = 0.3) or clinically relevant pancreatic leak (21% vs. 21%, P = 0.8). The incidence of SIRS in the TLPD group was significantly less than that of OPD group on POD 1 (9% vs. 24%, P < 0.001). Within a subset of 179 patients without postoperative complication, the incidence of SIRS in the TLPD group was significantly less than that of OPD group on POD 1 (2% vs. 13%, P = 0.01) and POD 2 (4% vs. 15%, P = 0.03). Multivariate analysis revealed that increased body mass index (> 27) (HR 1.7, 95% CI 1.1 - 2.6, P = 0.005), OPD (HR 1.8, 95% CI 1.1 - 2.9, P = 0.01) and postoperative complication (HR 2.3, 95% CI 1.4 - 3.7, P < 0.001) were independently associated with SIRS on POD 1 and/or 2.
Conclusion: TLPD independently reduced the early incidence of SIRS after pancreatoduodenectomy. The laparoscopic approach to pancreatoduodenectomy appears to provide an advantage of less invasiveness compared with the open approach especially in patients that do not develop postoperative complications.