Comparative Analysis Of The Efficacy Of Laparoscopic Central Pancreatectomy And Laparoscopic Distal Pancreatectomy For Benign Tumors Of The Pancreatic Neck

Aim:For pancreatic neck lesions,there are distal pancreatectomy(DP)or central pancreatectomy(CP)two surgical methods.As laparoscopy matures and surgeons improve their surgical skills,a large number of studies have shown that laparoscopic pancreatic resection is not only comparable to open pancreatic resection in terms of safety and feasibility,but also has significant advantages in post-operative rehabilitation and long-term survival.However,the choice of hysteroscopic surgery for pancreatic neck tumors remains controversial.The aim of this study was to analyze the advantages and disadvantages of laparoscopic distal pancreatectomy(LDP)and laparoscopic central pancreatectomy(LCP)for tumors in the pancreatic neck by comparing the specific outcomes of the two procedures.Materials and Methods:Clinical data of patients treated with LDP or LCP for pancreatic neck body lesions from January 2014 to December 2022 were collected from the Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Nanchang University.The results were divided into two groups,the LDP group(n=34)and the LCP group(n=16).The diagnosis was confirmed preoperatively by CT or MRI.Clinical data were reviewed for demographic and clinical features,intraoperative and postoperative data,and pathological findings.Endocrine and exocrine dysfunction of the pancreas was assessed by follow-up of patients with new onset diabetes and the use of trypsin.Our institutional ethics committee reviewed and approved the research plan and obtained the informed consent of all patients.Results:There Baseline features(Gender,Age,BMI,Main diameter,Child-Pugh grade)of both groups had no significant difference(P<0.05).Compared with LDP group.Compared with LDP group,the LCP group showed signifificantly longer operation time(392±142 vs 269±130 minutes,P=0.007),time to oral intake(3.8±1.3 vs2.8±0.9 days,P=0.017),hospital stay(19.6±5.1 vs 15.4±4.1 days,P=0.008),and higher hospital expenses(10.1±6.2 vs 6.6±1.5 Wan RMB,P=0.023).Moreover,there were no significant differences for conversion rate(0/16 vs 0/34),blood loss(154±93 vs 211±170ml,P=0.224),postoperative WBC(13.5±4.4 vs12.5±4.8x10~9/L,P=0.432),the random blood glucose after operation(8.2±2.1 vs8.6±2.6mmol/L,P=0.696),ascites amylase after surgery(5212±3110 vs3142±604U/L,P=0.167)for the two groups.There were also no significant differences for postoperative diabetes(1/16 vs 5/34),However,In addition,the incidence of pancreatic fistula grade B+C(P=0.005)and postoperative bleeding(P=0.031)was significantly higher in the LCP group compared with the LDP group.Conclusions:Our study showed that for benign tumors of the body of the pancreatic neck,both LCP and LDP are safe and feasible surgical procedures,but the risk of serious postoperative complications is higher with LCP.Therefore,in order to maximize patient benefit as much as possible,the preferred surgical approach for benign tumors of the body of the pancreatic neck is LDP.