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Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center

Abstract

Background

Laparoscopic pancreaticoduodenectomy (LPD) is a feasible option in selected patients. However, its use has not yet been generalized since it is time-consuming, physically demanding, and technically challenging. It might be essential to share the experience of high-volume centers to understand its use.

Methods

We retrospectively reviewed the data of 500 consecutive patients who underwent LPD at a single institution between January 2007 and December 2017.

Results

The patients included 272 women and 228 men (mean age, 57.1 years). The most common indication for LPD was intraductal papillary neoplasm (n = 104, 20.8%). Overall and major (Clavien–Dindo grades III–V) complication rates were 37.2% and 4.8%, respectively. Fifty-four patients (10.8%) had clinically relevant (grade B/C) pancreatic fistulas. There were 3 (0.6%) 90-day mortalities. The most common late complication was bilioenteric stricture (25, 5%). Two hundred thirty patients were diagnosed with periampullary cancer. The 5-year overall survival rates of pancreatic cancer, common bile duct cancer, ampulla of Vater cancer, and duodenal cancer were 37.4, 63.2, 78, and 88.9%, respectively. We analyzed learning curves of first-generation and second-generation surgeons. A risk-adjusted cumulative sum analysis demonstrated a learning curve of 55 cases for LPD with the first-generation surgeon and earlier competency with the second-generation surgeon.

Conclusions

LPD has the potential to become an alternative surgery to open pancreaticoduodenectomy for periampullary tumors with acceptable outcomes. We could reduce the steep learning curve with structured training, close supervision, and well-trained operation teams. Perioperative and oncologic outcomes of LPD will be optimized after overcoming the learning curve.

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Funding

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, South Korea (Grant Number: HI14C2640).

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Correspondence to Song Cheol Kim.

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Disclosures

Ki Byung Song, Song Cheol Kim, Woohyung Lee, Dae Wook Hwang, Jae Hoon Lee, Jaewoo Kwon, Guisuk Park, Yejong Park, and Seung Jae Lee have no conflicts of interest or financial ties to disclose.

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Song, K.B., Kim, S.C., Lee, W. et al. Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center. Surg Endosc 34, 1343–1352 (2020). https://doi.org/10.1007/s00464-019-06913-9

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Keywords

  • Laparoscopic pancreaticoduodenectomy
  • Survival
  • Complications
  • Learning curve