Laparoscopic Resection as an Alternative to Open Pancreatoduodenectomy

A randomized clinical trial has compared key-hole (laparoscopic) surgery and open surgery in pancreatic cancer patients undergoing pancreaticoduodenectomy, or the Whipple procedure. The procedure is used to treat tumors located in the head of the pancreas and adjacent areas, where approximately 75% of pancreatic cancer tumors occur.

In the 64-patient trial, which was carried out at GEM Hospital and Research Center, in India, showed overall complications and pathological outcomes did not differ, but laparoscopy offered reduced blood loss, decreased blood transfusions, fewer wound infections, and shorter hospital stays compared with open surgery.

Patients with periampullary cancers were randomized to either laparoscopic or open pancreatoduodenectomy. The outcomes evaluated were hospital stay (primary outcome), and blood loss, radicality of surgery, duration of operation and complication rate (secondary outcomes).

Of 268 patients, 64 who met the eligibility criteria were randomized, 32 to each group. The median duration of postoperative hospital stay was longer for open pancreaticoduodenectomy than for laparoscopy (13 (range 6–30) versus 7 (5–52) days respectively; P = 0·001). Duration of operation was longer in the laparoscopy group. Blood loss was significantly greater in the open group (mean(s.d.) 401(46) versus 250(22) ml; P < 0·001).

Number of nodes retrieved and R0 rate were similar in the two groups. There was no difference between the open and laparoscopic groups in delayed gastric emptying (7 of 32 versus 5 of 32), pancreatic fistula (6 of 32 versus 5 of 32) or postpancreatectomy haemorrhage (4 of 32 versus 3 of 32). Overall complications (defined according to the Clavien–Dindo classification) were similar (10 of 32 versus 8 of 32). There was one death in each group.

"Major surgeries like cancer operations performed with a laparoscopic approach offer significant advantages to patients," said Prof. Chinnusamy Palanivelu, lead author of the British Journal of Surgery study.

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Source-Eurekalert