Laparoscopic vs Open Pancreaticoduodenectomy: Overall Outcomes and Severity of Complications Using the Accordion Severity Grading System

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Abstract
Minimal access surgery techniques have evolved to include complex surgical procedures. Laparoscopic pancreaticoduodenectomy (LPD) is a complex operation that pancreas surgeons have been slow to adopt. This article reviews our experience with patients undergoing LPD and compares their outcomes with those of patients undergoing open pancreaticoduodenectomy (OPD). All patients undergoing OPD or LPD during a 6-year period (2005-2011) were included. Results from the 2 groups were compared for mortality and morbidity according to the Accordion Severity Grading System. Oncologic markers, including margins of resection, transfusions received, number of lymph nodes, and lymph node ratio, were also compared. During the study time period, 215 and 53 patients underwent OPD and LPD, respectively. No differences were seen in patient demographics, comorbidities, American Society of Anesthesiologists grade, or pathology. Significant differences favoring LPD were seen in intraoperative blood loss (p < 0.001), transfusions (p < 0.001), length of hospital stay (p < 0.001), and length of ICU stay (p < 0.001). Operative time was significantly longer for LPD (p < 0.001). There were no differences in overall complications, pancreas fistula, or delayed gastric emptying. Oncologic outcomes demonstrated no significant differences in resection margins, size of tumor, or T/N stages. There were significant differences in number of lymph nodes retrieved (p = 0.007) and lymph node ratio (p < 0.001) in favor of LPD. This series demonstrates that LPD appears to be safe and feasible, with benefits over the open counterpart. However, the increased complexity and effort demanded by the technique pose the need for multi-institutional series and standardization in reporting. The goal should be to assess if LPD can result in a better procedure with better outcomes.