Total Laparoscopic Pancreaticoduodenectomy For Pancreatic Ductal Adenocarcinoma: Oncologic Advantages Over Open Approaches?
Kristopher P Croome, Michael Farnell, Florencia G Que, Kaye Reid-Lombardo, Mark Truty, David Nagorney, Michael L Kendrick
Mayo Clinic, Rochester, MN
OBJECTIVE(S): Advantages of total laparoscopic pancreaticoduodenectomy(TLPD) include less blood loss and shorter hospital stay compared to open pancreaticoduodenectomy(OPD). Published oncologic outcomes of TLPD are limited by sample size and grouping of various cancer types. Our aim was to evaluate the oncologic outcomes of TLPD and OPD in patients with pancreatic ductal adenocarcinoma(PDAC).
METHODS: Single institution, retrospective review of all patients undergoing TLPD(n=108) and OPD(n=214) for PDAC from July 2007 to July 2013.
RESULTS: Neoadjuvant therapy, tumor size, node positivity and margin positive resection were not different between the two groups. Median hospital stay was greater in the OPD group (9 vs 6 days, p<0.001). A greater proportion of patients in the OPD group had a delay of greater than 8weeks from surgery to adjuvant chemotherapy, 41% and 27% respectively (p=0.01). The proportion of patients with a delay of more than 90days or did not receive adjuvant treatment was also greater in the OPD(12%) compared to the TLPD(5%) group(p=0.04). Median follow-up was 1.5years. Overall survival was not different between the two groups (p=0.22), however, progression free survival was greater in the TLPD group(p=0.03).
CONCLUSIONS: TLPD not only provides the typical benefits of MIS approaches, but in patients with PDAC it may also prevent delayed initiation or cancellation of adjuvant therapy. In comparable patients, this study also demonstrated improved progression free survival for patients undergoing TLPD.
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