Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports: Initial experience and perioperative outcomes

Table 1 Patient demographics and surgical data n (%)

Characteristic	Median (range)
Patients	21
Age (yr)	66 ± 12
Body mass index	25 (17-37)
ASA score	3 (2-3)
Sex, female/male	13/8
Disease status
Benign	3 (14.3)
Malignant	18 (73)
Parenchymal background (n)
Soft	9
Intermediate	6
Solid	6
Type of procedure
Pylorus-preserving	14 (95)
Operative time (min)	316 (260-410)
Estimated blood loss (mL)	240 (30-1000)
Conversion rate	1 (4.9)
Number of lymph nodes retrieved	14 (8-26)

Table 2 Final diagnosis and histologic findings

Diagnosis	n (%)
Pancreatic ductal adenocarcinoma	6
Intraductal papillary mucinous neoplasm	2
Ampullary adenocarcinoma	8
Cholangiocarcinoma	2
Cyst adenoma	2
Duodenal adenoma	1
Specimen characteristics
Tumor size, median (range) (cm)	3 (1.6-5.0)
Margin-negative, R0 resection	20 (95)
Regional lymph node metastases	5 (24)

Table 3 Surgical outcomes and complications n (%)

Modality	5 (24.6)
Pancreatic anastomotic leak	1 (4.9)
Delayed gastric emptying	2 (9.7)
Postoperative pneumonia	1 (4.9)
Surgical site infection	1 (4.9)

Table 4 Publications with laparoscopic pancreatioduodenectomy surgical outcomes

Ref.	n	HA/total	OT (min)	EBL (mL)	PF n (%)	M n (%)	HS (d)
Gagner et al[1] 1994	2	2/0	NA	NA	NA	NA	NA
Gagner et al[2] 1997	10	2/8	510	NA	2 (20)	NA	NA
Dulucq et al[20] 2006	25	12/13	287	107	NA	27	NA
Staudacher et al[21] 2005	4	4/0	416	325	0	0	12
Mabrut et al[22] 2005	3	1/2	300	300	NA	NA	7
Lu et al[23] 2006	5	0/5	528	770	NA	3 (60)	NA
Zheng et al[24] 2006	1	NA	390	50	NA	NA	30
Palanivelu et al[17] 2007	42	0/42	370	65	3 (7.1)	NA	10
Cai et al[25] 2008	1	0/1	510	800	0	0	14
Pugliese et al[3] 2008	19	7/6	482	180	3 (23.1)	7 (54)	18
Sa Cunha et al[26] 2008	2	0/2	510	300	1 (50)	1 (50)	19
Gumbs et al[13] 2008	3	0/3	NA	NA	1 (33)	1 (33)	NA
Ammori et al[14] 2011	7	1/6	628	350	1 (14.3)	2 (28.6)	11
Total	124	28/76	448	325	11.6	22 (28.6)	16
The current study	21	0/21	316	280	1	26.7	14

HA: Pancreatic head; OT: Operative time; EBL: Estimated bleeding loss; M: Morbidity; HS: Hospital stay; NA: Not available. PF: Pancreatic fistula.