Comparative Analysis Of Laparoscopic Duodenum-preserving Pancreatic Head Resection And Laparoscopic Pancreatoduodenectomy

Objective:Comparative analysis of short-term outcome and long-term quality of life after laparoscopic duodenum-preserving pancreatic head resection(LDPPHR)and laparoscopic pancreatoduodenectomy(LPD)in the treatment of benign or low-grade malignant tumors of the pancreatic headMethods:Retrospective collection of data on patients underwent LDPPHR and LPD at Department of Biliary-Pancreatic Surgery in our hospital from May 29,2018 to June 17,2021.The preoperative baseline data,intraoperative indicators and postoperative complications between the two groups were compared.The quality of life of patients one year after surgery was scored by the European organization for research and treatment of cancer,Quality of life questionnare-core30(EORTC QLQ-C30),and the long-term quality of life after LDPPHR and LPD was compared.Results:In this study,a total of 49 patients with benign or low-grade pancreatic malignant tumors were included in the reserch,including 18 in the LDPPHR group and 31 in the LPD group.In the LDPPHR group,the median age was 59 years(24-73),with 10 males(55.6%)and 8 females(44.4%);The median age of LPD group was 53 years(23～74),with 12 males(38.7%)and 19 females(61.3%).According to the preoperative American Society of Anesthesiologists(ASA)score of the two groups,in the LDPHR group,there were 0 cases of grade I(0.0%),14 cases of grade II(77.8%),and 4 cases of grade III(22.2%);In LPD group,there were 7 cases of grade I(22.6%),17 cases of grade II(54.8%),and 7 cases of grade III(22.6%).The body mass index(BMI)of the two groups was similar(21.5 ± 2.8 vs22.2 ± 2.4).The preoperative data in groups(including age,sex,ASA,BMI)with no significant difference(P>0.05).There was no significant difference in clinical data between the two groups(P>0.05)The patients of both groups successfully accepted the relevant operation,and no conversion to laparotomy.Compared with the intraoperative bleeding,the median bleeding volume of LDPPHR group and LPD group was 100 m L,with no significant difference(P>0.05).The operative time in the LDPPHR group was longer than that in the LPD group [316 min(210～510)vs.298min(205～520)],with no significant difference(P>0.05).Comparison of visual analog scale(VAS)scores in the first four days after operation between the two groups.The median score was 4(0～5)in the LDPPHR group and 2(1～7)in the LPD group on the first postoperative day,and the difference was statistically significant(P=0.003).There was no significant difference in the VAS scores on the second,third and fourth days afterward(P>0.05).Postoperative pancreatic fistula(POPF),bile leakage,delayed gastric emptying(DGE)and bleeding had no significant difference between the two groups(P>0.05).In the LDPPHR group,22.2%(4/18)of patients occurred biochemical leak,and the biochemical leak in LPD group was 16.1%(5/31).The data of the two groups were comparable,but the difference was not statistically significant(P>0.05).No grade B/C pancreatic fistula occurred in either group.The postoperative secondary operation rate in the LDPPHR group was higher than that in the LPD group(16.7% vs.0.0%,P=0.019).The postoperative hospital stay in the LDPPHR group was shorter than that in the LPD group,[15 d(12～36)vs.19 d(12～33)],but the difference was not statistically significant(P>0.05).One case(5.6%)in the LDPPHR group was readmitted due to bile duct stenosis within 30 days after discharge,while no case was readmitted within 30 days after operation in the LPD group.The difference was not statistically significant;there was no death case within 90 days after operation in both groups.The long-term complication rate in the LDPPHR group was lower than that in the LPD group(22.2% vs 58.1%,P=0.019),and the exocrine dysfunction in the LDPPHR group was significantly lower than that in the LPD group(16.7% vs.48.4%,P=0.034).In the EORTC QLQ-C30 score,there was no significant difference between the two groups in health status and functional scale scores(P>0.05).Compared with the LPD group,but postoperative diarrhea symptoms in LDPPHR group were better than those in LPD group(0 vs.33.3,P=0.038).Conclusion:Compared with LPD,LDPPHR has better short-term efficacy and faster postoperative recovery.LDPPHR with a lower long-term complication rate,better exocrine function of the digestive tract,and the postoperative long-term quality of life of patients is more ideal.LDPPHR is safe and feasible in the treatment of benign or low-grade malignant tumors of the head of the pancreas.