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Laparoscopic pancreatoduodenectomy: safety concerns and no benefits

2019; Elsevier BV; Volume: 4; Issue: 3 Linguagem: Inglês

10.1016/s2468-1253(19)30006-8

2468-1253

Oliver Strobel, Markus W. Büchler,

Gallbladder and Bile Duct Disorders

The safety of pancreatic surgery has significantly improved in the past two decades, with mortality of around 3% in high-volume centres. 1 Strobel O Neoptolemos J Jager D Buchler MW Optimizing the outcomes of pancreatic cancer surgery. Nature Rev Clin Oncol. 2019; 16: 11-26 Crossref PubMed Scopus (363) Google Scholar However, high morbidity (up to 40%) and a pronounced volume–outcome relationship (with mortality above 10% in low-volume settings) remain unsolved problems. 1 Strobel O Neoptolemos J Jager D Buchler MW Optimizing the outcomes of pancreatic cancer surgery. Nature Rev Clin Oncol. 2019; 16: 11-26 Crossref PubMed Scopus (363) Google Scholar Minimally invasive surgery can improve outcomes by reduction of operative trauma and faster postoperative recovery; this approach has been widely adopted for many surgical procedures including distal pancreatectomy but not for pancreatoduodenectomy, the standard operation for tumours in the pancreatic head and periampullary region. Pancreatoduodenectomy is among the most complex of all surgical procedures and involves both a difficult resection close to major vessels and a complex reconstruction. Laparoscopic pancreatoduodenectomy requires advanced skills in both pancreatic and laparoscopic surgery and there have been concerns as to the safety of its implementation. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trialAlthough not statistically significant, laparoscopic pancreatoduodenectomy was associated with more complication-related deaths than was open pancreatoduodenectomy, and there was no difference between groups in time to functional recovery. These safety concerns were unexpected and worrisome, especially in the setting of trained surgeons working in centres performing 20 or more pancreatoduodenectomies annually. Experience, learning curve, and annual volume might have influenced the outcomes; future research should focus on these issues. Full-Text PDF Correction to Lancet Gastroenterol Hepatol 2019; 4: 186–87Strobel O, Büchler MW. Laparoscopic pancreatoduodenectomy: safety concerns and no benefits. Lancet Gastroenterol Hepatol 2019; 4: 186–87—In the third paragraph of this Comment, the p value for complication-related 90-day mortality should read p=0·20. This correction has been made to the online version as of Feb 7, 2019; the printed version is correct. Full-Text PDF