Clinical Analysis Of Two Different Approaches Of Pancreatoduodenectomy On Pancreatic Head Cancer

Objective: To investigate the clinical value of two different approaches of pancreatoduodenectomy(PD),and provide clinical experience and theoretical basis for the improvement of surgical methods for PD.Methods: The clinical data and follow-up data of 66 cases of pancreatic head cancer were retrospectively analyzed,who underwent pancreatoduodenectomy from Aug.2014 to Dec.2016 in the second general surgery department in the first hospital of Lanzhou University.It was devided into 2 group(SMA-PD group,SMA-PD group),the former concluds 30 cases which underwent with SMA approach,the latter group 36 cases which underwent with SMV approach.Observation indicators: Intraoperative indicators(surgical time,volume of blood loss,the number of lymph node dissections,R0 resection rate);Postoperative indexes(TNM staging,the rate of positive surgical margin,postoperative complications);Total hospital cost,postoperative hospital stay;Follow-up(survival,tumor recurrence and metastasis).Results: There was no significant difference in preoperative general data between the two groups(P>0.05).Intraoperative data: The operation time is(5.11±0.65)h in SMA-PD group,and(5.70±0.75)h in SMV-PD group,statistically significant difference exists(t=3.382,P<0.05);The volume of blood loss is(230.00±83.90)ml in the SMA-PD group,and(280.14±102.15)ml in the SMV-PD group,statistically significant difference exists(t=2.150,P<0.05);The number of lymph node dissection in the SMA-PD group is more than that in the SMV-PD group(14.8±2.0 vs12.7±1.7,t=4.596,P<0.05);The R0 resection rate is 80%(24/30)in the SMA-PD group,and55.6%(20/36)in the SMV-PD group,showing a statistically significant difference(Z=4.4,P<0.05).The TNM stage in the two groups: patients with I,II and III of TNM stage are 13,14,3cases in the SMA-PD grouprespectively,and 16,18,2 cases in the SMV-PD group,showing no statistically significant difference(Z=4.4,P>0.05).The positive surgical margin in the SMA-PD group are(2 cases of pancreatic neck margin,1 case of common bile duct margin,1 case of SMV margin,3 cases of SMA margin,1 case of posterior margin of pancreatic head),the positive surgical margin in the SMV-PD group are(3 cases of pancreatic neck margin,2 cases of common bile duct margin,1 case of SMV margin,8 cases of SMA margin,1 case of posterior margin ofpancreatic head),there was no statistically significant difference exists(P>0.05).Postoperative data: The postoperative complications in the SMA-PD group are(1 case of biochemical leak,1case of B grade,0 case of C grade),(2 cases of biliary fistula),(1 case of postoperative hemorrhage),(3 cases of gastric retention),(2 cases of diarrhea),(4 cases of abdominal infection),the postoperative complications in the SMV-PD group are(2 case of biochemical leak,1 case of B grade,1 case of C grade),(1 case of biliary fistula),(3 cases of postoperative hemorrhage),(2cases of gastric retention),(1 case of diarrhea),(5 cases of abdominal infection),there was no statistically significant difference exists(P>0.05).The days of hospitalization in the SMA-PD group is(20.07±6.68)days and the hospitalization cost is(7.53±0.49)ten thousand yuan,and the SMV-PD group is(21.00±4.72)days and the hospitalization cost is(7.65±0.58)ten thousand yuan,showing no statistically significant difference between the two groups(P>0.05).The results of follow-up: 3 cases were lost to follow-up during the 1-year follow-up period,in which 2 cases is of the SMA-PD group and 1 case is of the SMV-PD group.The one-year tumor recurrence and metastasis: there were 1 case of local recurrence of tumor and 3 cases of distant metastasis in the SMA-PD group,and 3 cases of local recurrence,4 cases of distant metastases,2 cases of local recurrence with distant metastases in the SMV-PD group,showing no statistically significant difference between the 2 groups(P>0.05).The one-year-motality: 2 died in the SMA-PD group and 5 in the SMV-PD group,showing no statistically significant difference between the 2 groups(P>0.05).The one year survival time of the two groups was no statistically significant difference(χ2=0.879,P> 0.05).Conclusions: Compared with the SMV-PD,we found that the SMA-PD surgery could not only shorten the operation time,reduce the amount of intraoperative blood loss,determine the tumor resectability,and facilitate the lymph node dissection,more consistent with the(no touch)principle of tumor,but also do not increase the incidence of postoperative complications.The results showed that SMA-PD has a certain clinical application value.