Comparative Analysis Of Total Laparoscopic And Open Pancreaticoduodenectomy At A Single Institution

Background :Minimally invasive surgery technique have evolved to include complex surgical procedures rapidly,including minimally invasive pancreaticoduodenectomy(MIPD)that has become increasingly popular in recent years.MIPD includes laparoscopic pancreaticoduodenectomy(LPD)and robotic pancreaticoduodenectomy(RPD).Total laparoscopic pancreaticoduodenectomy(TLPD)is a complex operation that only well experienced laparoscopic surgeon need to perform,adopted only in high volume tertiary centre.However,the procedure is relatively new and controversy on feasibility,safety and effectiveness remains when comparing with the MIPD or TLPD with open classic pancreaticoduodenectomy(OPD);therefore,we aimed to compare our findings in a single institution peformed by the single surgeon and the surgical team in our department of hepato-biliary and pancreatic surgery..Hypothesis:The main focus of our study is to test the hypothesis of total Laparoscopic Pancreaticoduodenectomy is a safe and effective therapeutic compared to open pancreaticoduodenectomy in a single center.Study Design and method:This is a retrospective study method for all the patients undergoing Open and Total Laparoscopic Pancreaticoduodenectomy from January,2014 to December,2016 in the first Hospital of Jilin University.In our study we mainly evaluated intra-operative outcomes,oncologic data,post-operative complications,post-operative recovery and hospital stay.We also studied our experience in learning curve differences divided into two groups,Early phase and late phase.Setting:Provincial Tertiary Referral Centre Main outcome Result:In our study time period,84 patients underwent pancreaticoduodenectomy,among them,we divided two groups one selected for Laparoscopic and another for Open pancreaticoduodenectomy.Among them,43 patients were performed OPD(51%)and 41 patients for TLPD(48%)were successfully performed.There were no differences seen in patient demographics,co morbidities,American society of Anesthesiologists grade.There were Significant changes favoring TLPD group intraoperatively and postoperatively.Intra-operative Mean operative blood loss was significantly less in the laparoscopic(134.5ml)compared to the open group(327.79ml)(P<0.0001),mean ICU stay,2.82 days vs.4.16 days(P< 0.003)and mean postoperative hospital stay,13.75 days Vs 23.6 days,(P<0.0001).There were no significant differences in operative time and main Complications:pancreatic fistula,postpancreatectomy hemorrhage and Delayed gastric delaying.There were significant differences in a mean number of lymph nodes retrieved in TLPD(7.67)vs.OPD(4.54),(P<0.0034)in favor of TLPD.In our learning curve,the mean operative time was shorter in the late group compared with the early group(298 vs.256 min,respectively),The average intra-operative blood loss was(155 vs.115 ml,respectively),however,there was no much difference in total hospital stay,Intensive care unit stay and post operative main complications.Conclusions:This series of study clearly demonstrates that TLPD appears to be safe,feasible with encouraging post operative results in properly selected patients but only performed by skilled laparoscopic surgeons over traditional open surgery.