Pancreatoduodenectomy

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16.1 Laparoscopic Pancreaticoduodenectomy

Introduction

The first pancreatoduodenectomy was described by Kausch in 1909; however, Allen O. Whipple popularized the procedure for pancreatic head adenocarcinoma in 1935 as a two-stage operation with his report of seven cases. The procedure traditionally involves the en bloc removal of the gastric antrum, duodenum, pancreatic head, gallbladder, and bile duct. The pylorus-preserving technique was introduced by Traverso and Longmire in 1978. Pancreatoduodenectomy was previously accompanied by a mortality rate of 20% to 25%. Currently, however, most experienced pancreatic surgery centers report a mortality rate of 3% or less. The morbidity remains high at 20% to 50%, with the most impactful complication being a pancreatic fistula.

The most common indications for pancreatoduodenectomy are periampullary tumors, predominantly cancers of the pancreatic head. Cystic pancreatic neoplasms, particularly intraductal papillary mucinous neoplasms (IPMNs), can have malignant potential and have become an indication for pancreatic resection with greater frequency over the last few decades.