Laparoscopic pancreaticoduodenectomy for benign and malignant diseases

Laparoscopy still is not universally accepted as an alternative approach for pancreatoduodenectomy. This study aimed to assess the feasibility and safety of laparoscopic pancreatoduodenectomy for benign and malignant lesions of the pancreas, and to examine whether this procedure obtains adequate margins and follows oncologic principles. To the best of the authors' knowledge, their series of laparoscopic pancreatoduodenectomies is the largest reported to date.

A prospective study of laparoscopic pancreatoduodenectomy was undertaken between March 1999 and June 2005. The study enrolled 25 patients (16 women and 9 men) with a mean age of 62 +/- 14 years. All the operations were performed in a single institution.

The operations were performed without serious complications. Three patients underwent conversion to open surgery. For 13 patients, the anastomosis was performed intracorporeally. For the remaining 9 patients, the resection was performed laparoscopically, with the reconstruction performed through a small midline incision. There was no intraoperative mortality. The mean operating time was 287 +/- 39 min, and the mean blood loss was 107 +/- 48 ml. The mean time to the first bowel movement was 6 +/- 1.5 days, and the mean time to independent self-care was 4.8 +/- 0.8 days. Seven patients experienced postoperative complications. One patient died of a cardiac event 3 days after uncomplicated surgery. The mean hospital stay was 16.2 +/- 2.7 days. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 18 +/- 5.

Laparoscopic pancreatoduodenectomy for selected cases of benign and malignant lesions performed by highly skilled laparoscopic surgeons is feasible and safe. This method can obtain adequate margins and follow oncological principles. Larger series and longer follow-up periods are needed to establish the current results.