Laparoscopic Assisted Pancreaticoduodenectomy in Periampullary Tumors

Year 2021, , 61 - 69, 06.04.2021

Serkan Zenger Uğur Can Bülent Gürbüz Çağrı Bilgiç Erman Sobutay Orhan Bilge

https://doi.org/10.5505/deutfd.2021.97769

Abstract

INTRODUCTION: In line with the developments in technology, the number of minimally invasive procedures in pancreatic surgery is increasing gradually in order to reduce the morbidity rates. We aimed to present the results of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumors in our clinic.
METHODS: Data of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumor between April 2014 and August 2020 were retrospectively analyzed. Demographic and clinical characteristics, surgical outcomes, postoperative results and pathological data of the patients were presented.
RESULTS: Of the 30 patients, 12 (40%) were female, 18 (60%) were male, and the mean age was 64±14. Laparoscopy was converted open technique in 5 (13.3%) patients. The mean operative time was 378±72 minutes and the mean length of hospital stay was 10±4 days. In postoperative period, 7 (23.3%) patients had minor complications and 4 (13.3%) patients had major complications. Major complications were grade B pancreatic fistula in 3 patients and intraabdominal abscess in 1 patient. Pathological diagnosis of patients were adenocarcinoma in 20 (66.7%) patients, intrapapillary mucinous neoplasm in 6 (20%) patients, solid pseudopapillary neoplasm in 2 (6.6%) patients, neuroendocrine tumor in 1 (3.3%) patient and gastrointestinal stromal tumor in 1 (3.3%) patient. The mean number of harvested lymph nodes was 16.5±8.2.
DISCUSSION AND CONCLUSION: Laparoscopic assisted pancreaticoduodenectomy is a feasible method due to the advantages of minimally invasive procedures such as reducing local complications, morbidity, and length of hospital stay. However, we believe that laparoscopic assisted pancreaticoduodenectomy should be performed by teams experienced in laparoscopy in selected patients.

Keywords

Laparoscopy, periampullary tumor, pancreaticoduodenectomy, complication

Periampuller Bölge Tümörlerinde Laparoskopi Yardımlı Pankreatikoduodenektomi

Abstract

GİRİŞ ve AMAÇ: Teknolojideki gelişmeler doğrultusunda, morbidite oranlarını azaltmak amacıyla pankreas cerrahisinde de minimal invaziv girişimlerin sayısı giderek artmaktadır. Bu çalışmada, kliniğimizde periampuller bölge tümörlerinde laparoskopi yardımlı pankreatikoduodenektomi uyguladığımız hastaların sonuçlarını paylaşmayı amaçladık.
YÖNTEM ve GEREÇLER: Nisan 2014 ile Ağustos 2020 yılları arasında periampuller bölge tümörü nedeniyle laparoskopi yardımlı pankreatikoduodenektomi uygulanan hastaların demografik ve klinik özellikleri, ameliyat verileri, postoperatif sonuçları ve patolojik verileri retrospektif olarak incelendi.
BULGULAR: Çalışmaya dahil edilen 30 hastanın 12’si (%40) kadın, 18’i (%60) erkek, ortalama yaşları 64 ± 14 idi. Beş (%13,3) hastada açık yönteme geçildi. Ortalama ameliyat süresi 378 ± 72 dakika ve ortalama hastanede kalış süresi ise 10 ± 4 gündü. Postoperatif dönemde, 7 (%23,3) hastada minor komplikasyon, 4 (%13,3) hastada ise major komplikasyon saptandı. Major komplikasyonlar; 3 hastada grade B pankreatik fistül ve 1 hastada ise karın içi apse idi. Hastaların patolojik tanıları; 20’sinde (%66,7) adenokarsinom, 6’sında (%20) intrapapiller müsinöz neoplazm, 2’sinde (%6,6) solid psödopapiller neoplazm, 1’inde (%3,3) nöroendokrin tümör ve 1’inde (%3,3) ise gastrointestinal stromal tümör idi. Ortalama çıkarılan lenf nodu sayısı 16,5 ± 8,2 idi.
TARTIŞMA ve SONUÇ: Laparoskopi yardımlı pankreatikoduodenektomi, lokal komplikasyonları ve morbiditeyi azaltması, hastanede kalış süresini kısaltması gibi minimal invaziv girişimlerin sağladığı avantajlar nedeniyle uygulanabilir bir yöntemdir. Ancak laparoskopi yardımlı pankreatikoduodenektomi için, uygun hasta seçimi ile birlikte bu işlemin laparoskopi konusunda tecrübeli ekipler tarafından uygulanması gerektiği kanaatindeyiz.

Keywords

laparaskopi, periampuller tümör, pankreatikoduodenektomi, komplikasyon

References

• Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408-10.
• Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205:222-30.
• Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, ve ark. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008;18:13-8.
• Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145:19-23.
• Khatkov I, Izrailov R, Tyutyunnik P, Khisamov A, Andrianov A, Fingerhut A. One hundred and forty five total laparoscopic pancreatoduodenectomies: A single centre experience. Pancreatology. 2017;17:936-42.
• Poves I, Burdio F, Morato O, Iglesias M, Radosevic A, Ilzarbe L, ve ark. Comparison of Perioperative Outcomes Between Laparoscopic and Open Approach for Pancreatoduodenectomy: The PADULAP Randomized Controlled Trial. Ann Surg. 2018;268:731-9.
• Langan RC, Graham JA, Chin AB, Rubinstein AJ, Oza K, Nusbaum JA, ve ark. Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures. Surgery. 2014;156:379-84.
• Adam MA, Thomas S, Youngwirth L, Pappas T, Roman SA, Sosa JA. Defining a Hospital Volume Threshold for Minimally Invasive Pancreaticoduodenectomy in the United States. JAMA Surg. 2017;152:336-42.
• Conrad C, Basso V, Passot G, Zorzi D, Li L, Chen HC, ve ark. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc. 2017;31:3970-8.
• Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Lee D, ve ark. A comparative study of laparoscopic vs. open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis. J Am Coll Surg. 2015;220:177-85.
• Khaled YS, Fatania K, Barrie J, De Liguori N, Deshpande R, O'Reilly DA, ve ark. Matched Case-Control Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy for Malignant Lesions. Surg Laparosc Endosc Percutan Tech. 2018;28:47-51.
• Song KB, Kim SC, Lee W, Hwang DW, Lee JH, Kwon J, ve ark. Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center. Surg Endosc. 2020;34:1343-52.
• Wang X, Cai Y, Jiang J, Peng B. Laparoscopic Pancreaticoduodenectomy: Outcomes and Experience of 550 Patients in a Single Institution. Ann Surg Oncol. 2020;27:4562-73.
• Zhou W, Jin W, Wang D, Lu C, Xu X, Zhang R, ve ark. Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis. Cancer Commun (Lond). 2019;39:66.
• Dokmak S, Fteriche FS, Aussilhou B, Bensafta Y, Levy P, Ruszniewski P, ve ark. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 2015;220:831-8.
• Kamarajah SK, Bundred JR, Marc OS, Jiao LR, Hilal MA, Manas DM, ve ark. A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy. HPB (Oxford). 2020;22:329-39.
• Tian F, Wang YZ, Hua SR, Liu QF, Guo JC. Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy. BMC Surg. 2020;20:89.
• Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, ve ark. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584-91.
• Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, ve ark. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761-8.
• Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518-26.
• Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, ve ark. Multi-institutional Validation Study of the American Joint Commission on Cancer (8th Edition) Changes for T and N Staging in Patients With Pancreatic Adenocarcinoma. Ann Surg. 2017;265:185-91.
• Gagner M, Pomp A. Laparoscopic pancreatic resection: Is it worthwhile? J Gastrointest Surg. 1997;1:20-5; discussion 5-6.
• Pham H, Nahm CB, Hollands M, Pang T, Johnston E, Pleass H, ve ark. Hybrid laparoscopic pancreaticoduodenectomy: an Australian experience and a proposed process for implementation. ANZ J Surg. 2020.
• Kuesters S, Chikhladze S, Makowiec F, Sick O, Fichtner-Feigl S, Hopt UT, ve ark. Oncological outcome of laparoscopically assisted pancreatoduodenectomy for ductal adenocarcinoma in a retrospective cohort study. Int J Surg. 2018;55:162-6.
• Palanivelu C, Senthilnathan P, Sabnis SC, Babu NS, Srivatsan Gurumurthy S, Anand Vijai N, ve ark. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg. 2017;104:1443-50.
• Torphy RJ, Friedman C, Halpern A, Chapman BC, Ahrendt SS, McCarter MM, ve ark. Comparing Short-term and Oncologic Outcomes of Minimally Invasive Versus Open Pancreaticoduodenectomy Across Low and High Volume Centers. Ann Surg. 2019;270:1147-55.