İlhan ECE, Hüseyin YILMAZ, Serdar YORMAZ, Bayram ÇOLAK, Mustafa ŞAHİN, Hüsnü ALPTEKİN, Ertuğrul KAFALI

PANKREAS KANSERLERİNDE LAPAROSKOPİK VE AÇIK WHIPPLE PROSEDÜRÜNÜN KARŞILAŞTIRILMASI: TEK MERKEZ SONUÇLARI

AMAÇ: Pankreas tümörleri için uygulanan laparaskopik prosedür teknik olarak zor olduğu için yaygın olarak uygulanmamaktadır. Çalışmanın amacı, laparaskopik ve açık yöntemlerle proksimal pankreas tümörleri için ameliyat edilmiş hastaları, ameliyat öncesi bulguları, ameliyat sonrası bulguları, onkolojik sonuçları ve sağ kalım sürelerine göre karşılaştırmaktır. GEREÇ VE YÖNTEM: 2009 ve 2017 tarihleri arasında pankreatik rezeksiyon yapılmış olan hastaların bilgileri toplandı. Açık (TPD) ve laparaskopik total pankreatikoduodenektomi (TLPD) yapılmış hastalar bu çalışmaya dahil edildi. Hastalar, ameliyattan sonra en az 6 ay takip edildi ve tüm komplikasyonlar değerlendirildi. Komplikasyonların tümü kaydedildi ve Clavien sistemine göre sınıflandırıldı. BULGULAR: 62 (%80.5) hastaya TPD, 15 (%19.4) hastaya TLPD uygulandı. hastaların demografik bulgularına göre farklılıkları yoktu. TLPD grubunda, kan transfüzyonu, kan kaybı, hastanede kalış süreleri, yoğun bakımda kalma süreleri, çıkarılan lenf nodu sayıları açısından belirgin farklılıklar tespit edildi. Ameliyat süresi TLPD grubunda belirgin düzeyde uzundu. Pankreatektomi sonrası kanama TLPD grubunda düşüktü. Diğer komplikasyonlar açısından fark yoktu. SONUÇ: Laparaskopik whipple prosedürü düşük morbidite ve kabul edilebilir düzeydeki komplikasyon oranı ile sadece uygulanabilir değil aynı zamanda güvenli bir yöntemdir. TLPD, düşük kan kaybı, düşük transfüzyon oranı, yüksek sayıda lenf nodu çıkarılması, düşük yara yeri enfeksiyonu riski ile karakterizedir. Buna rağmen TLPD, ancak seçilmiş olgularda uygulanabilmektedir.

LAPAROSCOPIC VERSUS OPEN WHIPPLE PROCEDURE FOR PANCREATIC ADENOCARCINOMA: A SINGLE-CENTER EXPERIENCE

PURPOSE: The laparoscopic approach for pancreas tumors is notcomprehensively approved, due to its technical complexity. The aimof this study was to compare the perioperative and postoperativeresults, oncological outcomes and survival of patients with aproximal pancreatic tumor who underwent laparoscopic treatment(TLPD) versus an open procedure (TPD).MATERIAL AND METHODS: A retrospective evaluationwas made of the data of patients who underwent pancreaticresection between 2009 and 2017. All patients undergoing totalpancreaticoduodenectomy (TPD) or TLPD were included in thisstudy. The patients were followed up for a minimum of 6 monthspostoperatively and all complicationswere recorded,and analysedaccording to the Clavien system categories.RESULTS: TPD was applied to62 (80.5%) patients, and TLPD to15 (19.4%). No significant differences were determined betweenthe groups in respect of patient demographic data. Significantdifferences were determined in the TLPD group in respect of bloodtransfusion, blood loss, length of stay in hospital and intensive careunit (ICU), and thenumber of lymph nodes resected. Operating timewas significantly longer in the TLPD group. Post-pancreatectomyhemorrhage was lower in the TLPD group, and there were nodifferences in respect of other complications.CONCLUSION: The laparoscopic Whipple procedure is not onlyfeasible but safe, with low morbidity and acceptable complicationrates. TLPD is characterized by less blood loss, lower transfusionrates, improved lymph node resection, and less wound infection.However, the laparoscopic Whipple procedure should be applied inselected cases.

PDF

___

1.)Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 2005; 19:1028-1034.
2.)Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 2006; 20:1045-1050.
3.)Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DG. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg 2015; 262: 372–377.
4.)Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 2012; 215(6): 810-819.
5.)Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O et al. Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 2009;198(3):445-9.
6.)Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250:187-196
7.)Stauffer JA, Coppola A, Villacreses D, Mody K, Johnson E, Li Z, Asbun HJ. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long term results at a single institution. Surg Endosc 2017; 31: 2233-2241
8.)Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA et al. Metaanalysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 2014; 20:17626-17634.
9.)Bracale U, Pignata G, Lirici MM, Cristiano GS Hüscheet, Raffaele Pugliese,Giovanni Sgroi et al. Laparoscopic gastrectomies for cancer: The ACOI-IHTSC national guidelines. Minim Invasive Ther Allied Technol 2012; 21:313-319.
10.)Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994; 8:408-10.
11.)Horacio J Asbun, FACS, John A Stauffer. Laparoscopic vs Open Pancreaticoduodenectomy: Overall Outcomes and Severity of Complications Using the Accordion Severity Grading System, J Am Coll Surg 2012; 6: 810-819.
12.)Kuroki T, Adachi T, Okamoto T. A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepatogastroenterology 2012; 59:570-3.
13.)Kuroki T, Eguchi S. Laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma. Surg Today 2015; 45:808-12.
14.)Kim SC, Song KB, Jung YS, Kim YH, Park DH, Lee SS et al. Shortterm clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc 2013; 27:95-103.
15.)Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg 2010; 145:19-23.
16.)Yao HS, Wang Q, Wang WJ, Hu ZQ. Intraoperative allogeneic red blood cell transfusion in ampullary cancer outcome after curative pancreatoduodenectomy: a clinical study and metaanalysis. World J Surg 2008; 32(9):2038–46.
17.)Hyung WJ, Noh SH, ShinDW, Huh J, Huh BJ, Choi SH, Min JS. Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer. Ann Surg Oncol 2002; 9(1):5–12.
18.)Stephenson KR, Steinberg SM, Hughes KS, J T Vetto, P H Sugarbaker, and A E Chang. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann Surg 1988; 208(6):679–87
19.)Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 2011; 35:2739-2746.
20.)Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg 2015; 19:189-94; discussion 194.
21.)Lei P,Wei B, GuoW, Wei H. Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety. Surg Laparosc Endosc Percutan Tech 2014; 24:296–305.
22.)Correa-Gallego C, Dinkelspiel HE, Sulimanoff I, Fisher B, Viñuela EF, Kingham TP. Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 2014; 218(1): 129–39.
23.)Song KB, Kim SC, Hwang DW, Lee JH, Lee DJ, Lee JW et al. Matched Case- Control Analysis Comparing Laparoscopic and Open Pylorus-preserving Pancreaticoduodenectomy in Patients With Periampullary Tumors. Ann Surg 2015; 262:146-55.
24.)de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Laméris JS, van Gulik TM et al, Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg. 2005; 241:85–91.
25.)Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al, Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138:8-13.
26.)Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008; 18(1):13-8.
27.)Callery MP, Pratt WB, Vollmer CM. Prevention and management of pancreatic fistula. Journal of Gastrointestinal Surgery 2009;13(1): 163-173.
28.)Lai ECH, Lau SHY, Lau WY. Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review. Archives of Surgery 2009; 144(11): 1074-1080.
29.)Marcus SG, Cohen H, Ranson JHC. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Annals of Surgery 1995; 221(6): 635-648
30.)Suzuki Y, Fujino Y,Tanioka Y, Hiraoka K, Takada M, Ajiki T et al. Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size. Archives of Surgery 2002; 137(9): 1044-1048.
31.)Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL. Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg 2000; 231:293-300.
32.)Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandezdel Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001; 136: 391-8.
33.)Hartel M, Wente MN, Hinz U, Kleeff J, Wagner M, Müller MW et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus- preserving Whipple procedure. Arch Surg 2005; 140: 1094-9.
34.)Kim DK, Hindenburg AA, Sharma SK, Suk CH, Gress FG, Staszewski H et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? Ann Surg Oncol 2005; 12:222-7.
35.)Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR et al. Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761-768
36.)Wente MN, Shrihande SV, Kleeff J, Müller MW, Gutt CN, Büchler MW, Friess H. Management of early hemorrhage from pancreatic anastomoses after pancreaticoduodenectomy. Dig Surg 2006; 23: 203-208.
37.)Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg. 1994; 168:295-298.
38.)Rumstadt B, Schwab M, Korth P, Samman M, Trede M. Hemorrhage after pancreatoduodenectomy. Ann Surg. 1998; 227:236 –241.
39.)Zeh HJ, Zureikat AH, Secrest A, Dauoudi M, Bartlett D, Moser AJ. Outcomes after robotassisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol 2012; 19:864-870.