Laparoscopic pancreatoduodenectomy: safety concerns and no benefits
Mené sur 40 patients atteints d'une tumeur péri-ampullaire ou pancréatique bénigne, pré-cancéreuse ou cancéreuse puis sur 99 autres patients, cet essai multicentrique de phase II/III compare, du point de vue des complications, de la mortalité et du délai avant récupération des fonctions physiques et digestives, deux techniques de pancréatoduodénectomie, l'une par voie laparoscopique et l'autre par voie ouverte
The safety of pancreatic surgery has significantly improved in the past two decades, with mortality of around 3% in high-volume centres.1
However, high morbidity (up to 40%) and a pronounced volume–outcome relationship (with mortality above 10% in low-volume settings) remain unsolved problems.1
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.
The Lancet Gastroenterology & Hepatology , commentaire en libre accès, 2018