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Pancreatic Surgery for Pancreatic Adenocarcinoma: a Comparison Between the Laparoscopic and Open Surgical Approach.
John Stauffer*1, Alessandro Coppola2, Horacio J. Asbun1
1Mayo Clinic, Jacksonville, FL; 2Università Cattolica del Sacro Cuore, Rome, Italy
Introduction: With a more widespread adoption of minimally invasive pancreatic surgery, concerns have risen regarding the maintenance of oncologic principles when dealing with malignancy. The purpose of this study was to assess the adequacy of laparoscopic pancreatic resection (LPR) for patients with pancreatic adenocarcinoma (PADC).
Methods: A retrospective analysis of a prospectively maintained database was performed for all patient undergoing distal pancreatectomy (DP) (n=70) and pancreaticoduodenectomy (PD) (n=95) at a single institution. These groups were divided into open distal pancreatectomy (ODP) (n=29) vs laparoscopic distal pancreatectomy (LPD) (n=41), and open pancreaticoduodenectomy (OPD) (n=57) vs laparoscopic pancreaticoduodenectomy (LPD) (n=38). Age, Sex, BMI, Operative Time (OT), Estimated Blood Loss (EBL), Transfused Patient (TP), Vein Resection (VR), Multivisceral Resection (MR), Fistula Rates (PF), Delay Gastric Emptyng (DGE), Post-op Hemorrhage (PH), Lymph Node Dissection (LND), Tumor size (Ts), R0 Rate (R0r), ICU days (ICUd), Length of Stay (LOS), Clavien-Dindo classification complications, Mortality (M), disease free survival (DFS) and overall survival (OS) were compared for both groups.
Results: For DP the EBL, TP, LND, ICUd and LOS were significantly different between ODP and LDP, favoring LDP. In PD the OT is shorter for OPD. There is no statistically difference regarding EBL in the PD group, however the TP is statistically lower for LPD. No differences were observed in all other parameters in the DP or PD groups including disease free and overall survival.
Conclusion: This limited study suggests that LPR for PADC has similar oncologic results to open surgery. In addition, a significant decrease in TP was observed for LDP and LPD. Further studies are needed to assess if this difference is reproducible in larger matched series and as such, if it translates into any significant change in overall prognosis for these cancer patients.
Demographics and outcomes for patients undergoing laparoscopic and open pancreatic surgery for pancreatic adenocarcinoma
| Open DP | Laparoscopic
DP | p value | Open PD | Laparoscopic
PD | p value | | N0 patients | 29 | 41 | | 57 | 38 | | Age, years
(mean ± SD)
| 67 ± 11.2 | 72 ± 10.2 | p=0.057
n.s.
| 67.3 ± 9.5 | 67.6 ± 9.36 | p=0.87
n.s.
| BMI, Kg/m2
(mean ± SD)
| 26.1 ± 5.9 | 28.9 ± 8.0 | p=0.114
n.s.
| 26 ± 4.39 | 28.2 ± 5.55 | p=0.034 | Sex
(gender)
| M: 17
F: 12
| M: 24
F: 17
| p=0.997
n.s.
| M: 30
F: 27
| M: 22
F: 16
| p=0.61
n.s.
| Operative time,
min, (median)
| 310
(r:131-543)
| 248
(r:99-521)
| p=0.713
n.s.
| 343
(r:159-681)
| 515
(r:374-698)
| p<0.001 | Estimated blood loss,
ml, (median)
| 500
(r:150-3400)
| 150
(r:50-2500)
| p<0.001 | 400
(r:50-8500)
| 250
(r:50-4600)
| p=0.10
n.s.
| Transfused Patients
(number, %)
| 12 ( 41% ) | 8 ( 19.5% ) | p=0.046 | 20 ( 35% ) | 5 ( 13.1% ) | p=0.017 | Number of lymph nodes
dissected
(median)
| 7
(r:1-45)
| 23
(r:8-48)
| p<0.001 | 24
(r:6-57)
| 24
(r:6-57)
| p=0.16
n.s
| R0 rate
(number, %)
| 24 ( 82.7% ) | 38 ( 92.7% ) | p=0.58
n.s.
| 49 ( 85.9% ) | 36 ( 94.7% ) | p=0.172
n.s
| ICU days
(mean ± SD)
| 1.2 ± 2.92 | 0.3 ± 0.8 | p=0.049 | 2.18 ± 7.18 | 1.74 ± 7.83 | p=0.78
n.s
| Tumor Size,cm
(mean ± SD)
| 4.5 ± 3.2 | 3.7 ± 1.8 | p=0.156
n.s.
| 3.17 ± 1.03 | 2.6 ± 1.18 | p=0.015 | Pancreatic Fistula
Grade B - C
(number, %)
| 2 ( 6.8% ) | 5 ( 12.1% ) | p=0.67
n.s.
| 1 ( 1.7% ) | 4 ( 10.5% ) | p=0.06
n.s
| Clavien complication
(Grade 3-5)
(number, %)
| 7 ( 24.1% ) | 5 ( 12.1% ) | p=0.18
n.s.
| 7 ( 12.2% )
| 7 ( 18.4% ) | p=0.42
n.s
| DGE
Grade B - C
(number, %)
| 0 | 0 | N/A | 2 ( 3.5% ) | 4 ( 10.5% ) | 4 ( 10.5% ) | Hemorrhage
Grade B-C
(number, %)
| 0 | 0 | N/A | 3 ( 5.2% ) | 3 ( 7.8% ) | p=0.605
n.s
| Vein Resection
(number, %)
| 0 | 0 | N/A | 16 ( 28% ) | 10 ( 26.3% ) | p=0.8
n.s
| Multivisceral Resection
(number, %) | 10 ( 34.5% ) | 15 ( 36.5% ) | p=0.94
n.s. | 0 | 0 | N/A | 90 day mortality
(number, %)
| 1 ( 3.4% ) | 1 ( 2.4% ) | p=0.80
n.s.
| 3 ( 5.2% ) | 1 ( 2.6% ) | p=0.53
n.s
| Length of stay, days
( median)
| 8
(r:4-36)
| 5
(r:2-17)
| p<0.001 | 7
(r:4-43)
| 6
(r:4-68)
| p=0.8
n.s
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