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Ann Surg. 2019 Jan 17. doi: 10.1097/SLA.0000000000003190. [Epub ahead of print]

Practice Patterns and Perioperative Outcomes of Laparoscopic Pancreaticoduodenectomy in China: A Retrospective Multicenter Analysis of 1029 Patients.

Wang M1, Peng B2, Liu J3, Yin X4, Tan Z5, Liu R6, Hong D7, Zhao W8, Wu H9, Chen R10, Li D11, Huang H12, Miao Y13,14, Liu Y15, Liang T16, Wang W17, Cai Y2, Xing Z3, Cheng W4, Zhong X5, Zhao Z6, Zhang J18, Yang Z9, Li G10, Shao Y11, Lin G12, Jiang K13,14, Wu P13,14, Jia B15, Ma T16, Jiang C17, Peng S19, Qin R1.

Author information

1
Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
2
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
3
Department of Hepato-Pancreato-Biliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
4
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
5
Department of Hepatobiliary and Pancreatic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
6
The Second Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.
7
Division of General Surgery, Sir Run Run Shaw Hospital (SRRSH), Affiliated with the Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
8
Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
9
Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
10
Department of Pancreaticobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
11
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
12
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
13
Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
14
Pancreas Center, Nanjing Medical University, Nanjing, Jiangsu, China.
15
Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.
16
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
17
Department of Surgery, Huadong Hospital, Fudan University, Shanghai, China.
18
Division of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
19
Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

Abstract

OBJECTIVE:

The aim of the study was to analyze the outcomes of patients who have undergone laparoscopic pancreaticoduodenectomy (LPD) in China.

SUMMARY BACKGROUND DATA:

LPD is being increasingly used worldwide, but an extensive, detailed, systematic, multicenter analysis of the procedure has not been performed.

METHODS:

We retrospectively reviewed 1029 consecutive patients who had undergone LPD between January 2010 and August 2016 in China. Univariate and multivariate analyses of patient demographics, changes in outcome over time, technical learning curves, and the relationship between hospital or surgeon volume and patient outcomes were performed.

RESULTS:

Among the 1029 patients, 61 (5.93%) required conversion to laparotomy. The median operation time (OT) was 441.34 minutes, and the major complications occurred in 511 patients (49.66%). There were 21 deaths (2.43%) within 30 days, and a total of 61 (5.93%) within 90 days. Discounting the effects of the early learning phase, critical parameters improved significantly with surgeons' experience with the procedure. Univariate and multivariate analyses revealed that the pancreatic anastomosis technique, preoperative biliary drainage method, and total bilirubin were linked to several outcome measures, including OT, estimated intraoperative blood loss, and mortality. Multicenter analyses of the learning curve revealed 3 phases, with proficiency thresholds at 40 and 104 cases. Higher hospital, department, and surgeon volume, as well as surgeon experience with minimally invasive surgery, were associated with a lower risk of surgical failure.

CONCLUSIONS:

LPD is technically safe and feasible, with acceptable rates of morbidity and mortality. Nonetheless, long learning curves, low-volume hospitals, and surgical inexperience are associated with higher rates of complications and mortality.

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