Cpmparison Between Minimally Invasive And Open Pancreaticoduodenectomy:a Single Center Retrospective Study

Background:Laparoscopic approaches has gradually used in pancreaticoduodenectomy. However, the benefits of the laparoscopic approaches are still debated in clinical application. This article aims to present data regarding the efficacy of laparoscopic pancreaticoduodenectomy in a single center to analyze the blood loss in operation, operative time, the complication, hospital day, etc..Methods:From January 2013 to April 2015, a total of 17 patients underwent pancreaticoduodenectomy with laparoscopic approach, using a five-trocar technique. The conversions were principally due to bleeding(n=2) and adhesion (n=1).Reconstruction of the digestive tract was adapted to the aspect of the pancreatic stump, with 11 patients having pancreaticogastrostomy and 6 patients having pancreaticoenterostomy. When it comes to open pancreaticoduodenectomy, a total of 92 patients underwent operation with 58 of pancreaticoenterostomy and 33 of pancreaticogastrostomy and 1 patient having total pancreatic resection. The blood loss in operation, operation time, short-term outcomes, oncologic results, and complication, hospital day were retrospectively reviewed.Results:In the two groups of LPD and OPD, the mean operative time were 520.6(range, 420-720) min, and 375.8(range 251-720)min, respectively, having significant difference (p<0.05); and the mean blood loss was 294.1 (range,100-400)ml and 453.9(range 100-1500)ml, respectively, having significant difference (p<0.05). Mean hospital stay was 27.2 (range,11-52) days in LPD to 28.5(range,10-102) days in OPD, without significant difference (p>0.05). In LPD, Surgery-related morbidity occurred in 10 patients and included bleeding (n= 2), pancreatic fistula or(and) biliary fistula (n= 5), gastrointestinal dysfunction(n=3).4 is more than grade Ⅲ (23.5%). The resection margins were all free from disease; the collected lymph nodes was negative(n=12) and positive(n=5), and the mean cost in hospital was 121456.19 yuan. When it comes to OPD, Surgery-related morbidity occurred in 57 patients (59.3%),24 is more than grade III. The resection margins:89 free from disease, and 3 is not; the collected lymph nodes was negative(n=61) and positive(n=31), and the mean cost in hospital was 126425.15.Conclusions:Laparoscopic pancreaticoduodenectomy is feasible, safe, and oncologically adequate, but only if performed in selected cases by highly skilled laparoscopic surgeons. Laparoscopy showed significant advantage over traditional surgery on diminishing the blood loss in operation, but on other range, it did not show any advantages, and the operative time would be lengthened. However, it may be better, once the learning curve has been overcome.