Clinical Efficacy Of Laparoscopic Pancreaticoduodenectomy And Risk Factors Of Perioperative Complications

Objective: The purpose of this study was to describe the perioperative,short-term and long-term oncological results of 100 cases of laparoscopic total pancreaticoduodenectomy(LPD),analyze the influence of perioperative factors on the total complications,pancreatic fistula,bile leakage,delayed gastric emptying and postoperative bleeding,and analyze the risk factors,and explore the safety and feasibility of LPD in order to reduce postoperative complications and improve surgical safety.Methods: Between April 2015 and December 2017,clinical data of 100 total laparoscopic pancreaticoduodenectomy(LPD)procedures performed in the Department of Hepatobiliary-pancreatic Surgery,The first hospital of Jilin University,was retrospectively analyzed.Results: The median operative time was 290.0 min(interquartile range 266.3-321.8 min)and the median intraoperative estimated blood loss was 130mL(interquartile range 70.0-180.0 mL).Mean length of hospital stay was 13.4±8.5 days.Overall postoperative morbidity was 29.0%,including bleeding(n=8),pancreatic fistula(n=9,7 grade B and 2 grade C),bile leakage(n=6),delayed gastric emptying(n=7),intra-abdominal infection(n=14),pulmonary infection(n=7),postoperative severe complications(Clavien?III)were detected in 7 patients(7.0%).The in-hospital mortality was 2%.Pathologic diagnoses were pancreatic ductal adenocarcinoma(n=13),ampullary adenocarcinoma(n=24),duodenal adenocarcinoma(n=8),distal cholangiocarcinoma(n=34),intraductal papillary mucinous neoplasm(n=4),pancreatic neuroendocrine tumor(n=3),pancreatic serous cystadenoma(n=2),pancreatic solidpseudopapillary neoplasm(n=6),and others(n=4).Among patients diagnosed with malignancy,two had margin positive resection;the median number of harvested lymph nodes were 12(interquartile range 8–15)for malignancy.Tumor patients: The median follow-up time for pancreatic cancer,distal cholangiocarcinoma,and ampullary adenocarcinoma was 14 months,19.5 months,and 14 months,respectively.The median survival time of pancreatic cancer was 24 months.The 1-,2-,and 3-year overall survival rates of patients with distal cholangiocarcinoma were 93.71%,66.66%,and 66.66%,respectively.The 1-,2-,and 3-year overall survival rates of ampullary adenocarcinoma patients were 94.44%,87.70%,and 73.08%,respectively.The 1-and 2-year overall survival rates of patients with pancreatic cancer were 91.67% and 40.10%,respectively.Risk factor analysis: Univariate analysis suggested that age >65 years and diabetes were associated with complications,and multivariate analysis suggested that age >65 years and diabetes were independent risk factors for postoperative complications.Univariate analysis found that CA199?37,pancreatic duct diameter ?3mm,soft tissue of the pancreas was associated with the occurrence of pancreatic fistula.Multivariate analysis indicated that pancreatic soft tissue was an independent risk factor for postoperative pancreatic fistula.Univariate analysis of perioperative indicators and bile leakage and delayed gastric emptying did not identify risk factors;Univariate analysis found that age was associated with postoperative gastric emptying delay,and multivariate analysis suggested that age >65 years was postoperative independent risk factors for delayed gastric emptying.Conclusions:(1)Laparoscopic pancreaticoduodenectomy is a safe and feasible procedure for experienced pancreatic surgeons in larger pancreatic surgery centers.(2)LPD is effective in the treatment of tumors,especially ampullary cancer,but it still needs a large sample,which is further confirmed by multi-center prospective study.(3)Multivariate correlation analysis showed that age > 65 years old and diabetes mellitus were independent risk factors for postoperative complications,soft pancreas was an independent risk factor for pancreatic fistula,and age > 65 years old was an independent risk factor for delayed gastric emptying.Therefore,adjust the preoperative state of the elderly,diabetic patients to achieve the best,and fully communicate with their families before the operation,properly prolong the eating time,do a good job of early detection of postoperative complications and early treatment.Patients with soft pancreas should be paid close attention to the drainage properties of abdominal drainage fluid,amylase detection,abdominal ultrasonography,prolong the drainage time,pay attention to blood routine,biochemical,procalcitonin,C-reactive protein and other indicators,to avoid thedeterioration of the disease in early stage.