Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for carcinoma of the ampulla of Vater in a medium-volume center: a propensity score matching analysis

Abstract

Objective To compare the efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in a medium-volume medical center. Methods Data for patients who underwent OPD or LPD for carcinoma of the ampulla of Vater (VPC) between January 2017 and June 2022 were acquired retrospectively. Propensity score-matching (PSM) analysis was performed to balance the baseline characteristics between the groups. The primary outcome was disease-free survival (DFS). Cox regression analysis was used to explore the independent risk factors for DFS. Results A total of 124 patients with pathologically diagnosed VPC were included. After 1:1 matching, there were 23 cases each in the OPD and LPD groups. Kaplan–Meier survival analyses showed that the median DFS in the OPD and LPD groups was identical (16.0 months vs 16.0 months, respectively). Multivariate Cox regression analysis showed that low levels of alkaline phosphatase and γ-glutamyl transpeptidase, positive surgical margin, and lymph node enlargement were independent risk factors for DFS. Conclusion LPD in medium-volume centers with acceptable technical conditions may approach or even achieve the efficacy of LPD in large-volume centers.

No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

“…EPD, which has been rarely reported mostly in complex pancreaticoduodenal trauma, perforations, life-threatening hemorrhage, and severe infection is still a very uncommon procedure[ 1 ]. Recent rapid developments in technological innovations, improvements in surgical skills, progress in perioperative management, and the extensive experience of surgeons have proven the feasibility and safety of PD[ 6 ]. While the mortality rate of elective PD has shown a significant decrease during the last three decades, it remains higher for EPD[ 7 ].…”

“…To the best of our knowledge, this is the first report of a no-touch isolation technique performed to reduce intraoperative blood loss in EPD. In this procedure, all arteries that supply the pancreatic head region are first ligated and divided before manipulation of the pancreatic head and duodenum[ 6 , 33 , 34 ]. In conventional PD using Kocher’s maneuver, the GDA is usually ligated and divided during surgery; however, IPDA ligation and division are performed in the final stage of resection, which might induce further tumor bleeding.…”