Laparoscopic Pancreaticoduodenectomy With Open Reconstruction: The Buddha's Middle Path.

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Laparoscopic pancreaticoduodenectomy (LPD) adoption is limited by its technical difficulty.
• Laparoscopic pancreaticoduodenectomy with open reconstruction (LPOR) combines LPD benefits with simpler reconstruction.
• LPOR aims to mitigate LPD's learning curve while retaining minimally invasive advantages.

Purpose of the Study:

• To assess the feasibility and safety of LPOR.
• To compare perioperative and short-term oncologic outcomes of LPOR versus open pancreaticoduodenectomy (OPD).

Main Methods:

• Retrospective analysis of a prospectively maintained database (2013-2019).
• Comparison between 19 OPDs and 15 LPORs.
• LPOR involved laparoscopic resection and mini-laparotomy reconstruction.

Main Results:

• LPOR surgery duration was longer (410 vs. 360 min), but blood loss and hospital stay were reduced compared to OPD.
• No significant differences in complication rates (delayed gastric emptying, pancreatic fistulas) between LPOR and OPD.
• Similar lymph node yield and 100% R0 resection rates in both groups; LPOR had no wound-related complications.

Conclusions:

• LPOR demonstrates superior short-term outcomes compared to OPD.
• LPOR is not inferior to OPD regarding complications and oncologic results.
• LPOR presents a viable alternative for pancreaticoduodenectomy, balancing surgical approach benefits.