Outcome of laparoscopy assisted pancreaticoduodenectomy at the department of gastrointestinal surgery, Viet Duc University Hospital

 Abstract

Introduction: Laparoscopic-assisted pancreaticoduodenectomy is a complex surgical procedure associated with a high rate of complications, particularly those arising from anastomotic leakage. The combination of laparoscopic dissection and resection with a mini-laparotomy for specimen retrieval and anastomosis construction is thought to potentially reduce perioperative morbidity.

Patients and Methods: A cross-sectional descriptive case series was conducted involving 18 patients who underwent laparoscopically-assisted pancreaticoduodenectomy at the Department of Gastrointestinal Surgery, Viet Duc University Hospital, during the period from 2023 to 2025.

Results: A total of 18 patients underwent laparoscopic-assisted pancreaticoduodenectomy. Among these, 55.6% were diagnosed with ampullary adenocarcinoma, 22.2% with solid pseudopapillary neoplasms of the pancreas, and 11.1% with pancreatic neuroendocrine tumors. The mean operative time was 352.44 ± 44.59 minutes. The average length of the mini-laparotomy incision was 6.78 ± 1.67 cm. Mean intraoperative blood loss was 163.89 ± 136.99 ml. Postoperative complications included pancreatic fistula (27.7%), postoperative hemorrhage (5.6%), bile leak (5.6%), chyle leak (5.6%), and gastrointestinal bleeding (5.6%). All patients were alive at the time of analysis. The average postoperative hospital stay was 11.33 ± 3.27 days. The rate of discharge with good outcomes was 50.0%.

Conclusions: Laparoscopic-assisted pancreaticoduodenectomy is a safe alternative to open surgery and represents an appropriate transitional approach toward fully laparoscopic pancreaticoduodenectomy.

Keywords: Pancreaticoduodenectomy, Laparoscopy assisted surgery, Ampulla of Vater.

References

1. Hank T, Klaiber U, Sahora K, Schindl M, Strobel O. [Surgery for periampullary pancreatic cancer]. Chirurg. 2021;92(9):776-87.
2. Petrova E, Ruckert F, Zach S, Shen Y, Weitz J, Grutzmann R, et al. Survival outcome and prognostic factors after pancreatoduodenectomy for distal bile duct carcinoma: a retrospective multicenter study. Langenbecks Arch Surg. 2017;402(5):831-40.
3. 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(1):89.
4. Tran Que Son. Application of laparoscopic-assisted pancreaticoduodenectomy in the treatment of tumors of the ampulla of Vater [PhD thesis in Medicine] 2021.
5. Nigri G, Petrucciani N, La Torre M, Magistri P, Valabrega S, Aurello P, et al. Duodenopancreatectomy: open or minimally invasive approach? Surgeon. 2014;12(4):227-34.
6. Meng LW, Cai YQ, Li YB, Cai H, Peng B. Comparison of Laparoscopic and Open Pancreaticoduodenectomy for the Treatment of Nonpancreatic Periampullary Adenocarcinomas. Surg Laparosc Endosc Percutan Tech. 2018;28(1):56-61.
7. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 2012;215(6):810-9.
8. Dokmak S, Fteriche FS, Aussilhou B, Bensafta Y, Levy P, Ruszniewski P, et al. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 2015;220(5):831-8.
9. Senthilnathan P, Srivatsan Gurumurthy S, Gul SI, Sabnis S, Natesan AV, Palanisamy NV, et al. Long-term results of laparoscopic pancreaticoduodenectomy for pancreatic and periampullary cancer-experience of 130 cases from a tertiary-care center in South India. J Laparoendosc Adv Surg Tech A. 2015;25(4):295-300.
10. Kuesters S, Chikhladze S, Makowiec F, Sick O, Fichtner-Feigl S, Hopt UT, et al. Oncological outcome of laparoscopically assisted pancreatoduodenectomy for ductal adenocarcinoma in a retrospective cohort study. Int J Surg. 2018;55:162-6.
11. Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol. 2014;20(24):7864-77.
12. Zhang H, Lan X, Peng B, Li B. Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis. World J Gastroenterol. 2019;25(37):5711-31.
13. Maggino L, Liu JB, Ecker BL, Pitt HA, Vollmer CM, Jr. Impact of Operative Time on Outcomes after Pancreatic Resection: A Risk-Adjusted Analysis Using the American College of Surgeons NSQIP Database. J Am Coll Surg. 2018;226(5):844-57 e3.
14. Tran Que Son, Tran Manh Hung. post-operative complications of laparoscopic assisted pancreatoduodenectomy. Journal of Medical Research. 2020;125(1).
15. Song KB, Kim SC, Lee W, Hwang DW, Lee JH, Kwon J, et al. Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center. Surg Endosc. 2020;34(3):1343-52.
16. Ho Van Linh. Evaluation of outcomes following pancreaticoduodenectomy for the treatment of ampullary cancer [PhD thesis in Medicine]2016.
17. Xu J, Yang LX, Gu JY, Ma XL, Qiu JF. [Total laparoscopic pancreaticoduodenectomy for duodenal tumors: a report of 20 cases]. Zhonghua Wei Chang Wai Ke Za Zhi. 2019;22(8):789-91.
18. Yan JF, Pan Y, Chen K, Zhu HP, Chen QL. Minimally invasive pancreatoduodenectomy is associated with lower morbidity compared to open pancreatoduodenectomy: An updated meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Medicine (Baltimore). 2019;98(32):e16730.
19. Dagorno C, Marique L, Korrel M, de Graaf N, Thouny C, Renault G, et al. Long-term quality of life is better after laparoscopic compared to open pancreatoduodenectomy. Surg Endosc. 2024;38(2):769-79.