Effect of total laparoscopic versus open pancreaticoduodenectomy on short-term and oncological outcomes: a single-institution comparative study

Abstract

Background: Recently, the efficacy and outcomes of total laparoscopic pancreaticoduodenectomy (TLPD) have been well established; however, specific data regarding the clinical outcomes of total laparoscopic versus open pancreaticoduodenectomy (OPD) are still limited. The present study aims to directly compare the clinical and oncological outcomes following TLPD versus OPD at a single institution.

Methods: The clinical data of 127 consecutive patients who underwent TLPD (n = 69) and OPD (n = 58) and were admitted to our department between January 2017 and June 2019 were analysed retrospectively. The short-term and oncological outcomes in the two groups were compared.

Results: Compared to the OPD group, the TLPD group experienced a longer operative time [(399.1 ± 77.9) min vs. (247.9 ± 61.8) min] and significantly earlier oral intake [5.0 (IQR, 4.0-6.0) days vs. 8.0 (IQR, 6.0-8.0) days], earlier postoperative exhaust [3.0 (IQR, 3.0-4.0) days vs. 4.0 (IQR, 4.0-4.5) days], earlier out-of-bed activity [2.0 (IQR, 1.0-2.3) days vs. 3.0 (IQR, 2.0-3.0) days], earlier nasogastric tube removal [5.5 (IQR, 4.0-7.8) days vs. 8.0 (IQR, 6.0-11.0) days] and shorter postoperative length of hospital stay [14.0 (IQR, 11.0-21.0) days vs. 16.0 (IQR, 12.0-25.0) days] (P < 0.05). The estimated blood loss [(334.4 ± 157.8) mL vs. (344.6 ± 259.1) mL], presence of clinically relevant postoperative pancreatic fistula (grade B/C, 5.8% vs. 5.2%) and the overall complication rate (23.2% vs. 25.9%) did not significantly differ between the two groups (P > 0.05). Regarding the oncological outcomes, there were no significant differences in pathological types, tumour size, lymph nodes harvested, tumour stages or resection margins, or in overall survival (OS) (56.9% vs. 53.2%, P = 0.704) or progression-free survival (PFS) (48.3% vs. 46.8%, P = 0.881) with a median 26-month follow-up.

Conclusion: TLPD is a safe and feasible procedure in select patients after a certain learning curve. Compared with OPD, TLPD has equivalent short-term and oncological outcomes and offers the advantages of faster postoperative recovery and shorter length of hospital stay.

Keywords: Complications; Laparoscopy; Pancreaticoduodenectomy; Prognosis.