Published: 2019-02-25

A prospective randomized controlled trial comparing laparoscopic versus open Whipple’s procedure for periampullary malignancy

Pravin Bhingare, Sunil Wankhade, Brajesh B. Gupta, Sanjay Dakhore


Background: Laparoscopic surgery in cases of periampullary region malignancies has been emerging as a preferable alternative to open pancreatoduodenectomy due to their benefits such as early mobilization and shorter duration of hospital stay. We conducted this study to determine whether laparoscopic approach is comparable to open pancreatoduodenectomy in terms of hospital stay, blood loss, complications, pathological radicality with oncological safety and overall postoperative short-term outcomes.

Methods: This was a single-center, non-stratified, balanced allocation, open-label, parallel-group randomized control study in which patients who had undergone  Whipple’s procedure were included. Patients were randomized after confirmation of non-metastatic status into either the laparoscopy (N=15) or open surgery group (N=15). The primary outcome variable was duration of postoperative hospital stays. Secondary outcomes were duration of surgery, blood loss, complication rates (using definitions of the international study group of pancreatic surgery) and pathological radicality of resection.

Results: Pain in abdomen was the predominant complaint which was seen in 12 (80%) and 10 (66%) patients each. The other common symptoms were weight loss, vomiting and jaundice. Surgical site infection, mean blood loss and mean operative duration was significantly lower in laparoscopic group (P<0.05). Mean tumor size was more in open group. Mortality was comparable in both the groups.

Conclusions: Laparoscopic pancreatoduodenectomy offers significant benefit in terms of hospital stay, surgical site infection, mean blood loss, mean operative duration and mean interval of duration receiving chemo/radiotherapy as compared to open surgery in cases of periampullary region malignancy.


Complications, Laparoscopic surgery, Outcome, Periampullary region malignancies

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Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomy in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248-57.

Bramhall SR, Neoptolemos JP. Adjuvant chemotherapy in pancreatic cancer. Int J Pancreatol. 1997;21:59.

Buchler M, Friess H, Schultheiss KH, Gebhard C, Kubel R, Muhrer KH, et al. A randomized controlled trial of adjuvant immunotherapy (murine monoclonal antibody 494/32) in resectable pancreatic cancer. Cancer. 1991;68:1507.

Beger HG, Rau B, Gansauge F, Poch B. Treatment of pancreatic cancer: challenge of the facts. World J Surg. 2003;27:1075-84.

American Gastroenterological Association. American Gastroenterological Association medical position statement: epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma. Gastroenterol. 1999;117:1463-84.

Nishimura Y, Hosotani R, Shibamoto Y, Kokubo M, Kanamori S, Sasai K, et al. External and intraoperative radiotherapy for resectable and unresectable pancreatic cancer: Analysis of survival rates and complications. Int J Radiat Oncol Biol Phys. 1997;39:9.

Jin T, Altaf K, Xiong JJ, HuangW, Javed MA, Mai G, et al. A systematic review and meta-analysis of studies comparinglaparoscopic and open distal pancreatectomy. HPB (Oxford). 2012;14:711-24.

Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, et al. A totally laparoscopic pylorus-preserving pancreaticoduodenectomy and reconstruction. Surg Today. 2009;39:359-62.

Wei H,Wei B, Zheng Z, Huang Y, Huang J, Fang J. Comparative study of outcomes after laparoscopic versus open pancreaticoduodenectomy. Zhonghua Wei Chang WaiKe Za Zhi. 2014;17:465-8.

Dokmak S, Ftériche FS, Aussilhou B, Bensafta Y, Lévy P, Ruszniewski P, et al. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 2015;220:831-8.

Kim SC, Song KB, Jung YS, Kim YH, Park DH, Lee SS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc. 2013;27:95-103.

Asbun HJ, Stauffer J. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 2012;215:810-9.

Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg. 2009;16:731-40.

Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260:633-8.

Dokmak S, Ftériche FS, Aussilhou B, Bensafta Y, Lévy P, Ruszniewski P, et al. Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg. 2015;220:831-8.

Meng LW, Cai YQ, Li YB, Cai H, Peng B. Comparison of laparoscopic and open pancreaticoduodenectomy for the treatment of nonpancreatic periampullary adenocarcinomas. Surg Laparosc Endosc Percutan Tech. 2018;28(1):56-61.

Fischer CP, Hong JC. Method of pyloric reconstruction and impact upon delayed gastric emptying and hospital stay after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg. 2006;10(2):215-9.

Speicher PJ, Nussbaum DP, White RR, et al. Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol. 2014;21:4014-9.

Allen PJ, Gönen M, Brennan MF, Bucknor AA, Robinson LM, Pappas MM, et al. Pasireotide for postoperative pancreatic fistula. N Engl J Med. 2014;370(21):2014-22.

Ho CK, Kleeff J, Friess H, Buchler MW. Complications of pancreatic surgery. HPB (Oxford). 2005;7(2):99-108.