Laparoscopic pancreaticoduodenectomy: A systematic literature review

Background Laparoscopic pancreaticoduodenectomy (LPD) is gaining momentum, but there is still uncertainty regarding its safety, reproducibility, and oncologic appropriateness. This review assesses the current status of LPD. Methods Our literature review was conducted in Pubmed. Articles written in English containing five or more LPD were selected. Results Twenty-five articles matched the review criteria. Out of a total of 746 LPD, 341 were reported between 1997 and 2011 and 405 (54.2%) between 2012 and June 1, 2013. Pure laparoscopy (PL) was used in 386 patients (51.7%), robotic assistance (RA) in 234 (31.3%), laparoscopic assistance (LA) in 121 (16.2%), and hand assistance in 5 (0.6%). PL was associated with shorter operative time, reduced blood loss, and lower rate of pancreatic fistula (vs LA and RA). LA was associated with shorter operative time (vs RA), but with higher blood loss and increased incidence of pancreatic fistula (vs PL and RA). Conversion to open surgery was required in 64 LPD (9.1%). Operative time averaged 464.3 min (338–710) and estimated blood 320.7 mL (74–642). Cumulative morbidity was 41.2%, and pancreatic fistula was reported in 22.3% of patients (4.5–52.3%). Mean length of hospital stay was 13.6 days (7–23), showing geographic variability (21.9 days in Europe, 13.0 days in Asia, and 9.4 days in the US). Operative mortality was 1.9%, including one intraoperative death. No difference was noted in conversion rate, incidence of pancreatic fistula, morbidity, and mortality when comparing results from larger (C30 LPD) and smaller (B29 LPD) series. Pathology demonstrated ductal adenocarcinoma in 30.6% of the specimens, other malignant tumors in 51.7%, and benign tumor/disease in 17.5%. The mean number of lymph nodes examined was 14.4 (7–32), and the rate of microscopically positive tumor margin was 4.4%. Conclusions In selected patients, operated on by expert laparoscopic pancreatic surgeons, LPD is feasible and safe.