Laparoscopic Pancreaticoduodenectomy: Outcomes and Experience of 550 Patients in a Single Institution.

introductionLaparoscopic pancreaticoduodenectomy (LPD) is one of the most technically challenging surgical procedures, involving complicated dissection and reconstruction. Recently, enthusiasm for performing this procedure has increased; however, concerns have been raised regarding its perioperative and oncologic outcomes.

methodsWe retrospectively reviewed patients who underwent LPD between 2010 and 2019 at our institution. We analyzed perioperative and oncologic outcomes of LPD, risk factors associated with complications, and the learning curve.

results550 patients underwent LPD, including 473 standard LPD and 77 LPD with vascular resection. Of these, 38.5% experienced complications. Pancreatic fistula occurred in 24% of patients. Five patients died within 90 days. No significant differences were observed in terms of complications or 90-day mortality between patients who underwent LPD with vascular resection versus standard LPD. Patients with pancreatic cancer had the shortest median survival time (20 months); patients with duodenal or papillary cancer had the longest median survival time (50 months). Pancreatic cancer, American Society of Anesthesiologists (ASA) score, and operative time were risk factors associated with complications, and previous abdominal surgery, ASA score, and body mass index were risk factors associated with severe complications. Finally, surgeons who performed standard LPD had a learning period of 47 procedures, whereas surgeons who performed LPD with vascular resection were proficient after having performed 200 standard LPD procedures.

conclusionsLPD is a safe, feasible, and oncologically acceptable procedure when performed in a high-volume center. Performance of LPD should follow a step-by-step principle because of the long and steep learning curve.