Better perioperative outcomes with laparoscopic pancreatoduodenectomy

Last Updated: 2018-09-06

By Will Boggs MD

NEW YORK (Reuters Health) - Laparoscopic pancreatoduodenectomy leads to shorter hospital stays and more favorable postoperative course than open pancreatoduodenectomy, according to results from the PADULAP randomized controlled trial.

"We expected a shorter postoperative stay, but the most surprising result (and that we did not expect) was that there were much fewer serious complications in the group of patients operated by laparoscopy," Dr. Ignasi Poves from Hospital del Mar, in Barcelona, Spain, told Reuters Health by email.

Regardless of approach, pancreatoduodenectomy (PD) can be associated with severe morbidity and mortality. Studies of laparoscopic PD have yielded inconsistent results, with some showing high rates of severe postoperative complications and others showing better outcomes than with open PD.

Dr. Poves and colleagues compared perioperative outcomes between laparoscopic and open PD in their open-label randomized trial of 66 patients treated at their institution.

Eight of the 34 patients randomized to laparoscopic PD required conversion to open surgery because of suspicion of vascular involvement in four, technical difficulties due to the presence of biliary stenting in two and uncontrolled bleeding in two.

Mean length of hospital stay, the primary endpoint, was significantly shorter in patients undergoing laparoscopic PD than in patients undergoing open PD (13.5 days vs. 17 days, P=0.024), the team reports in the Annals of Surgery, online August 22.

Patients assigned to laparoscopic PD had significantly less severe postoperative complications, fewer poor-quality outcomes and fewer cumulative severity complications, compared with patients assigned to open PD.

Within 90 days following surgery, one patient (3.1%) in the laparoscopic PD group and five patients (17.2%) in the open PD group required reoperation (P=0.06).

Results were similar after excluding the eight patients in the laparoscopic PD group converted to open surgery.

"In my opinion, if there is no contraindication for the laparoscopic approach (basically based on the characteristics of the tumor and vascular involvement), this approach should be considered the first choice," Dr. Poves said.

"Laparoscopic PD is a technically demanding procedure that has only shown advantages for selected surgeons with experience in pancreatic and advanced laparoscopic surgery," he said.

"The message of the study is not that laparoscopic PD should now be done everywhere," Dr. Poves said. 'The message is, if you have extensive experience in this technique, the results can be better than the open pathway."

SOURCE: https://bit.ly/2NfO91F

Ann Surg 2018.