Laparoscopic Pancreatoduodenectomy: Results Evolution over 215 Procedures

Aim. To evaluate the outcomes of laparoscopic pancreatoduodenectomy (LPDE) along with experience accumulation.

Material and methods. Laparoscopic pancreatoduodenectomy was performed in 215 patients. There were hepatopancreatoduodenal  malignant tumors in 187 (87%) cases and benign diseases in 28  (13%) patients. Pylorussparing LPDE was performed in 55 (26%)  cases, gastropancreatoduodenectomy – in 160 (74%) patients. In 13 cases procedure was followed by segmental superior mesenteric vein/portal vein resection.

Results. Mean blood loss and time of surgery were 400 ml and 427 min, respectively. There was decrease of median operative time from 450 min in the first 50 operations to 320 min in the last 65 cases.  Pancreatic fistula occurred in 32 (14.8%) patients. There was  decrease of pancreatic fistula incidence from 21% in the first 100  patients to 9.6% in the last 115 cases. Delayed gastric emptying  occurred in 7% of patients, overall morbidity was 35.5% and mortality – 6%. In 70 patients with pancreatic adenocarcinoma  3-year overall survival rate (OSR) was 35.5%, 5-year – 25.2%,  median survival time – 22.5 months. In 11 patients with distal  cholangiocarcinoma 3-year OSR was 57%, 5-year survival was absent. In 31 patients with ampullary carcinoma 3-year and 5-year OSR were the same – 67%.

Conclusion. Laparoscopic pancreatoduodenectomy is safe and effective procedure. There was a tendency to improved outcomes along with experience accumulation.

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