Risk Factors For Perioperative Complications Of Laparoscopic Pancreaticoduodenectomy

Since first described in 1994[1],LPD(Laparoscopic Pancreaticoduodenectomy) has drawn the attention of the entire world during the past two decades.More and more centers have started to operate gradually,but because of the advanced laparoscopic skills required,the utilization of laparoscopic pancreaticoduodenectomy is still localized to a few centers.Lots of Comparative studies and meta analysis have demonstrated the typical advantages of LPD, namely, less blood loss* shorter hospital stay and better recovery,and there is no significant difference in postoperative morbidity and mortality rate between Laparoscopic and open approaches[3-5]. Furthermore,there are advantages of LPD in postoperative systemic inflammatory response and quality-of-life over OPD[6-7]. However,postoperative morbidity of LPD,including postoperative pancreatic fistule(POPF)、postoperative hemorrhage(PPH)、delayed gastric emptying (DGE)、biliary fistula、intra-abdominal infection,remain substantial,up to 30%-50%[8].Postoperative morbidity results in a prolonged hospital stay and greater cost,and in servere cases,leads to reoperation and mortality.Therefore,how to prevent and treat postoperative morbidity is the key to improve patients’ quality-of-life,and every surgeon of pancreatic surgery should focus on it.Our team establised a novel approach of LPD based on "Five Trocars" suitable for the eastern body habitus, and there were 160 LPDs performed by our team from September 2012 to February 2016.This study retrospectively analyse the risk factors for major perioperative complications of these 160 LPDs,in order to reduce the incidence of postoperative morbidity,and help to promote surgical safety.ObjectiveTo analyse the risk factors for major perioperative complications of laparoscopic pancreaticoduodenectomy, aiming to reduce the incidence of complications and improve operation safety and promote surgical safety.MethodsRetrospective analysis of the risk factors for major perioperative complications of laparoscopic pancreaticoduodenectomy operated by our team between September 2012 and February 2012.Putative risk factors were divided into three broad categories: 1)patient-related factors, such as age, gender, BMI,Hypertension,Diabetes,history of abdominal surgery,jaundice,diameter of pancreatic duct;2)surgery-related fators,such as operating time, time of pancreaticojejunostomy,estimated blood loss, intraoperative blood transfusions;3)disease-related factors, such as resectable or borderline resectable,size of lesion.ResultsOur team performed 160 LPDs between September 2012 and February 2016.Overall perioperative mortality was 0.6%(1/160).Perioperative morbidity was 35.6%(57/160),and severe complications (Clavien-Dindo classification≥Ⅲ) was 13.8 %(22/160).Perioperative morbidity included pancreatic fistule 31 (A 18,B 10,C 3),postoperative hemorrhage 16(A 2,B 4,C 10),biliary fistula 7(A 3,B 1,C 3),wound issue 7,pulmonary infection 3,Chylous fistula 2,delayed gastric emptying 1(B),Drug fever 1.Univariate analysis showed that age>65 was associated with overall perioperative morbidity, age≥65 and intraoperative blood loss≥200ml were associated with severe complications,male gendar、age≥65、pancreatic duct<3mm were associated with clinical pancreatic fistule,and age≥65 was associated with postoperative hemorrhage.Mutivariate analysis showed that age≥65 was the independent risk factors of overall perioperative morbidity、severe complications、clinical pancreatic fistule、 postoperative hemorrhage,intraoperative blood loss≥200ml was the independent risk factors of severe complications, and smaller pancreatic duct is the independent risk factors of clinical pancreatic fistule.ConclusionsAge≥65 was the independent risk factors of overall perioperative morbidity、 severe complications、clinical pancreatic fistule、postoperative hemorrhage,intraoperative blood loss≥200ml was the independent risk factors of severe complications,and smaller pancreatic duct is the independent risk factors of clinical pancreatic fistule.Hence,in elderly patients undergoing LPD,preoperative assessment and perioperative monitoring and management should be enhanced;improving the surgical technique and reducing the intraoperative blood loss, to a certain extent, can prevent the occurrence of serious complications; in patients with pancreatic duct<3mm,somatostatin analogues should be proactively used postoperatively,and prolong the extubation time properly and have a close monitoring of drainage fluid amylase.