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Laparoscopic Pancreatoduodenectomy Shortens Hospital Stay Compared with Open Pancreatoduodenectomy

Laparoscopic pancreatoduodenectomy (LPD) has been shown by the results of the PADULAP trial, which was conducted from 2013–2017, to lead to both shorter hospital stays and a more favourable outcome post-operation than open pancreatoduodenectomy (OP).

Researchers in the PADULAP randomised controlled trial set out to investigate the primary endpoint of length of hospital stay. The trial’s secondary endpoints included operative time, comprehensive complication index score, poor quality outcome, and Clavien–Dindo Grade ≥3 complications. This was a single-centre trial conducted at Hospital del Mar, Barcelona, Spain.

Eighty-six patients were assessed for pancreatoduodenectomy, of which 34 were randomised to LPD and 32 were randomised to OP. It was found that LPD resulted in a shorter length of hospital stay than OP, with a median of 13.5 days compared with 17 days (p=0.024), respectively. Furthermore, it was also shown that LPD demonstrated better outcomes in terms of comprehensive complication index score (20.6 versus 29.6; p=0.038), poor quality outcome (10 versus 14 patients; p=0.041), and Clavien–Dindo Grade ≥3 complications (5 versus 11 patients; p=0.04).

It should be noted that 8 patients originally assigned to LPD were transferred to OP, for either suspicion of vascular involvement, uncontrolled bleeding, or the presence of biliary stenting causing technical difficulties. However, once these 8 patients were excluded from the analysis, the results were similar.

Another point worth considering in assessing LPD against OP is the relative cost of the two interventions. The European Association for Endoscopic Surgery 2017 Clinical Consensus Conference noted that two studies have compared the cost of these interventions.1 A study by Mesleh et al.2 suggested an equivalent overall cost, while Tan et al.3 found a higher cost for LPD (¥8,1317.43 ± 2027.60 versus ¥78433.23 ± 5,788.12); Tan et al. noted that although the admission cost associated with LPD was lower, the cost associated with surgery was higher.

These results are encouraging and should be considered during clinical decision making when deciding which operational method is most suitable for a patient. One of the study researchers, Dr Ignasi Poves, Hospital del Mar, summed up the trial’s findings: “The message of the study is not that LPD should now be done everywhere. The message is, if you have extensive experience in this technique, the results can be better than the open pathway.”

 

References
  1. Edwin B et al.; EAES Consensus Conference Study Group. Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc. 2017;31(5):2023-41.