Laparoscopic Pancreaticoduodenectomy: A Single Team Preliminary Experience

Objective: The present study aimed to describe the authors' experience and the perioperative outcome for laparoscopic pancreaticoduodenectomy (LPD). Materials and Methods: Perioperative clinical data of 57 consecutive pancreaticoduodenectomy (PD) procedures performed from January 2014 to May 2016 in the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital were retrospectively analyzed. Results: The median of operative time was 315 minutes (range, 220 to 575 min) and the median of intraoperative estimated blood loss was 200mL (range, 100 to 550 mL). Conversion to open PD was required in 3 patients (5.3%) as a result of difficult dissection. Hand-assisted LPD was used in 2 patients (3.5%). Mean length of hospital stay was 14.8 days (8 to 29 d). Cumulative surgery-related morbidity was 28.1%, included bleeding (n=4), pancreatic fistula (n=3), biliary fistula (n=1), delayed gastric emptying (n=1), intra-abdominal infection (n=3), pulmonary infection (n=3), and ileus (n=1). Postoperative severe complications (Clavien >= III) were detected in 4 patients (7.0%) including 1 intra-abdominal infection, 2 postoperative bleeding event, and 1 afferent delayed gastric emptying. Three patients required reoperation. There was no 30-day or in-hospital mortality. Pathologic diagnoses were pancreatic ductal adenocarcinoma (n=5), ampullary adenocarcinoma (n=10), duodenal adenocarcinoma (n=24), distal common bile duct cancer (n=13), atypical hyperplasia of bile duct (n=2), and chronic pancreatitis (n=3). No patient had margin positive resection; the number of harvested lymph nodes were (16.7 +/- 4.2), the number of positive lymph nodes were (1.3 +/- 1.1). Conclusions: LPD, although complicated and difficult, serve as a safe and effective method for experienced surgeons.