Laparoscopic versus open pancreaticoduodenectomy for pancreatic or periampullary tumors: a multicenter propensity score-matched comparative study

Abstract

Background: Pancreaticoduodenectomy (PD) is a complex surgical procedure for which the use of minimally invasive approaches is still debated. The present study aims to compare the outcomes after laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) for pancreatic head and peri-ampullary tumors.

Methods: This is a retrospective multicenter study comparing 132 patients who underwent LPD with a historic cohort of OPD performed before LPD program implementation, by two pancreatic and laparoscopic surgeons in tertiary centers. After propensity score-matching (PSM), 85 LPD patients were matched with 85 OPD patients with similar preoperative characteristics and 90-day outcomes were compared.

Results: LPD was associated with significantly longer operative time (355 vs. 269 min; P = 0.001). Estimated blood loss were not different (median = 211 vs 277 mL; P = 0.141) and the conversion to open rate for LPD was 8.33% in the original cohort and 6% after PSM. LPD was not statistically different from OPD for severe complications rates (17.6% vs 24.7%; P = 0.348), clinically relevant POPF (17.6% vs 25.8%; P = 0.265), biliary leakage (17.6% vs 25.8%; P = 0.265), hemorrhage (12.9% vs 14.1%; P = 0.999), delayed gastric emptying rate (10.5% vs 5.8%; P = 0.404) and reoperation rate (12.9% vs 11.7%; P = 0.999). Length of stay in the LPD group was shorter than in the OPD group (15.13 vs. 19.44 days; P = 0.01). Mortality rates (3.5% vs. 0%; P = 0.245) did not differ between LPD and OPD groups. Regarding final histology, we found a higher number of lymph nodes in the LPD group (15.48 vs 13.46; P = 0.017) without difference on R0 rates.

Conclusion: LPD is a safe procedure when performed by pancreatic and laparoscopic surgeons and could lead to a shorter hospital stay and improve lymphadenectomy with similar postoperative outcomes to OPD.

Keywords: Laparoscopy; Minimally invasive surgery; Pancreaticoduodenectomy; Postoperative outcome.