• Manford Penn posted an update 2 days, 16 hours ago

    Perioperative result and survival analysis was calculated retrospectively Results: 84 Patients received ODP (RAMPS; 34 Pts) and 69 patients underwent LDP (RAMPS; 51 Pts). There were no differences in the number of harvested lymph node (12.1; ODP group vs 14.0;LDP group, P = 0.214), tumor size (4.00 cm; ODP group vs 3.42 cm; LDP group, P = 0.057), R0 resection rate (87.0%; ODP group vs 79.0%; LDP group, P = 0.524) between two groups. Hospital stay was shorter in LDP group over ODP group, and start of diet was faster in LDP group as well. Plus, rate of intraoperative transfusion was lower in LDP group. In survival analysis confined to stage I and II patients, LDP group showed better overall survival rate over ODP group, (1 yr; 76.1%, 3 yrs; 57.1%; LDP group vs 1 yr; 75.3%, 3 yrs; 40.9%; ODP group). (P = 0.019) However after excluding patients with combined vascular resection (either HAR or PV-SMVR) there was no difference in survival between LDP group (1 yr; 85.8%, 3 yrs; 56.7%) and ODP group (1 yr; 79.3%, 3 yrs; 44.5%). (P = 0.079) Conclusions: There seems to be increasing evidence that LDP is equivalent to ODP for Pancreatic cancer in terms of oncologic outcome. However, long term oncologic result will be required and further randomized prospective studies should be performed to support the validity of LDP for Pancreatic cancer. Keywords: Pancreatic cancer, Laparoscopic distal pancreatectomy, Opend distal pancreatectomy, RAMPS “”Background/aim: Pancreaticojejunal anastomosis sutured to a normal pancreas – with small duct and soft texture, reflects an increased risk for development of pancreatic fistula (PF) and overall morbidity, particularly in overweight patients. Performing pancreas-preserving total duodenectomy (PPTD) and avoiding the transection of the gland for pre- or low-grade malignant duodenal tumors, where pancreas is normal, could be a safer alternative to high-risk pancreaticoduodenectomy (HR-PD). Methods: All patients operated with PPTD and HR-PD between 2006–2011 at Karolinska University Hospital were retrieved from a prospective registry. The demographics, length of stay (LOS), postoperative morbidity and mortality and hospital costs were analyzed. Results: Twenty patients operated with PPTD and 81 with HR-PD were identified. Patients who underwent PPTD were younger than those with HR-PD (50 vs 62.4 yrs; p=0.0003). The percentage of obese patients was no different in the two groups (60 vs 45.7%; p=0.2). No differences were found in overall morbidity and surgery-specific complications. However, PPTD patients had less and less severe post-operative PF (15% vs 37.3%; p=0.06), fewer severe (Clavien grade≥3b) complications (20% vs 31%), less ICU stay (5% vs 12.4%), lower reoperation rate (10% vs 21%), lower mortality (0 vs 6.2%), and shorter LOS (16.9 days vs 24.6 days), but the numbers were too small to reach statistical significance. PPTD was performed with shorter operative time (319 min vs 418 min; p<0.