Detailed Abstract
[Plenary - Pancreas Disease/Surgery]
[PL 4] Postoperative outcome of 1029 patients with laparoscopic pancreaticoduodenectomy in china
Min Wang1, Bin Peng2, Jianhua Liu3, Xinmin Yin4, Zhijian Tan5, Rong Liu6, Defei Hong7, Wenxin Zhao8, Heshui Wu9, Rufu Chen10, Dewei Li11, Heguan Huang12, Kuirong Jiang13, Yahui Liu14, Tingbo Liang15, Wei Wang16, Yunqiang Cai2, Zhongqiang Xing3, Wei Cheng4, Xiaosheng Zhong5, Zhimin Zhao6, Jungang Zhang7, Zhiyong Yang9, Guolin Li10, Yue Shao11, Guirong Lin12, Pengfei Wu13, Baoxing Jia14, Tao Ma15, Zhongyi Jiang16, Suyou Peng17, Renyi Qin1
1Department of Biliary?Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
2Department of Pancreatic Surgery, West China Hospital, Sichuan University, China.
3Department of Hepato?Pancreato?Biliary Surgery, The Second Hospital of Hebei Medical University, China.
4Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, China.
5Department of Hepatobiliary and Pancreatic Surgery, Guangdong Province Hospital of Chinese Medicine, China.
6Department of Surgical Oncology (HBP), Chinese PLA General Hospital, China.
7Division of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, China.
8Department of General Surgery, The Affiliated Hospital of Xuzhou Medical College, China.
9Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
10Department of Pancreaticobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China.
11Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, China.
12Department of General Surgery, Fujian Medical University Union Hospital, China.
13Pancreas Center, The First Affiliated Hospital of Nanjing Medical University; Pancreas Institute, Nanjing Medical University, China.
14Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, China.
15Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, China.
16Department of Surgery, Huadong Hospital, Fudan University, China.
17Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, China. , China
Introduction : Despite debates concerning laparoscopic pancreaticoduodenectomy (LPD), enthusiasm for the procedure is increasing worldwide. However, a large, systematic, detailed, multicenter analysis of LPD has not been performed. The aim was to conduct a multicenter analysis of postoperative outcome of patients who underwent LPD retrospectively in China.
Methods : 14 high-volume pancreatic centers in China participated in this study. Data of consecutive patients who underwent LPDs between January 2010 and August 2016 were collected retrospectively and uni- and multi- variable analyses were performed.
Results : A total of 1029 patients who underwent LPD were included. There were 571 (55.5%) males with median operation time of 441 min (interquartile range, 360-530 min). In multivariable analyses, major complications (Clavien-Dindo ≥ IIIa) were found in 511 (49.7%) patients, including hemorrhage in 128 (12.4%), biliary fistula in 50 (4.9%), delayed gastric emptying in 172 (16.7%), and postoperative pancreatic fistula in 274 (26.6%) patients. 90-day mortality was present in 61 (5.9%) patients. Multicenter analysis of the learning curve revealed three phases, with proficiency thresholds at 35 and 80 cases. Furthermore, high hospital and department volume, great experience with open PD and minimally invasive surgery, and surgeon’s experience were associated with low risk of surgical failure.
Conclusions : LPD is feasible and technically safe, with acceptable morbidity and mortality rates, and other clinical outcomes. Clinical outcomes improve once the surgeons' learning curve has been overcome. However, for safer dissemination of LPD, clinicians must remember that the long learning curve, low hospital volume, and insufficient surgical experience were associated with high complication and mortality rates.
Methods : 14 high-volume pancreatic centers in China participated in this study. Data of consecutive patients who underwent LPDs between January 2010 and August 2016 were collected retrospectively and uni- and multi- variable analyses were performed.
Results : A total of 1029 patients who underwent LPD were included. There were 571 (55.5%) males with median operation time of 441 min (interquartile range, 360-530 min). In multivariable analyses, major complications (Clavien-Dindo ≥ IIIa) were found in 511 (49.7%) patients, including hemorrhage in 128 (12.4%), biliary fistula in 50 (4.9%), delayed gastric emptying in 172 (16.7%), and postoperative pancreatic fistula in 274 (26.6%) patients. 90-day mortality was present in 61 (5.9%) patients. Multicenter analysis of the learning curve revealed three phases, with proficiency thresholds at 35 and 80 cases. Furthermore, high hospital and department volume, great experience with open PD and minimally invasive surgery, and surgeon’s experience were associated with low risk of surgical failure.
Conclusions : LPD is feasible and technically safe, with acceptable morbidity and mortality rates, and other clinical outcomes. Clinical outcomes improve once the surgeons' learning curve has been overcome. However, for safer dissemination of LPD, clinicians must remember that the long learning curve, low hospital volume, and insufficient surgical experience were associated with high complication and mortality rates.
SESSION
Plenary
Room A 3/31/2018 11:00 AM - 11:50 AM