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• W3201623930 abstract "Presenter: Evelyn Waugh MD | London Health Sciences Centre Background: The open method has been the standard approach to pancreaticoduodenectomy (PD and is associated with significant morbidity. Laparoscopic PD is posited to reduce postoperative length of stay (LOS) and perioperative complications while maintaining comparable oncological outcomes to open PD. While literature demonstrates a trend toward a benefit of laparoscopic PD, this technique remains in its early years and more evidence must be accumulated as the approach becomes more refined. As one of the few centres in Canada routinely performing laparoscopic PD, London Health Sciences Centre (LHSC) is in a unique position to describe the utilization of this novel technique within the Canadian healthcare system. Methods: Data were collected prospectively from patients undergoing laparoscopic PD between 2018 – 2020 for any elective indication. This timeframe encompasses introduction and early utilization of the technique. Data were reported using descriptive statistics. Primary outcomes include POPF rate, LOS, in-hospital complications, 30d morbidity and mortality, 30d readmission and 30d re-operation. Secondary outcomes include R0 resection and time to recurrence. This examines the chronological trend associated with uptake and early utilization of laparoscopic PD including rates of conversion to open and reasons for conversion. These outcomes were compared to NSQIP institutional and collaborative data for all PD cases. Results: 127 patients underwent PD between January 2018 and November 2020. 17 were completed either laparoscopically or laparoscopic-assisted. 41% (n = 7) of laparoscopic cases were converted to open. Two were planned conversions, one had portal venous involvement requiring vascular reconstruction, one required hand port insertion for specimen palpation, one patient had significant adhesions, one had significant tumour bulk impairing adequate visualization and one patient was difficult to ventilate with pneumoperitoneum. All patients undergoing laparoscopic PD had resectable tumours. Mean operative time was 6 hours 28 minutes. 53% (n=9) experienced Clavien-Dindo Grade III or higher post-operative complication. Median length of stay was 10 days. POPF occurred in 17.6% (n = 3) and were all IPGFS-B. 35% (n = 6) required 30d readmission. 17.6% (n = 3) required re-operation due to gastric outlet obstruction, failure of the hepaticojejunostomy causing GDA bleeding secondary to bile erosion and concomitant missed enterotomy, and erroneous cutting and intra-abdominal retraction of an external pancreatic causing abscess formation. There was one 30-day mortality due to out of hospital cardiac arrest with no evidence of intra-abdominal complication on autopsy. R0 resection margins were achieved in all specimens. No patients had early recurrence. Median follow-up was 92 days (range = 15 – 584). Conclusion: This study demonstrates the early experience of our institution with laparoscopic PD. While some cases required conversion to open due to patient factors, conversions that were either planned or due to difficult dissection occurred earlier in adoption of this technique indicating the presence of a technical learning curve. Postoperative morbidity, readmission and reoperation remains higher than NSQIP reported rates which may also be attributable to early introduction of this approach. Oncologic resection was achieved in all cases. Future directions include a propensity-matched comparison to open PD and ongoing analyses as the technique mature." @default.
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• W3201623930 date "2021-01-01" @default.
• W3201623930 modified "2023-10-02" @default.
• W3201623930 title "Laparoscopic vs. open pancreaticoduodenectomy: a single centre's initial experience with introduction of a novel surgical approach" @default.
• W3201623930 doi "https://doi.org/10.1016/j.hpb.2021.06.284" @default.
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