Efficacy Of Laparoscopic Pancreaticoduodenectomy For Pancreatic Head Cancer

Objective : To compare the perioperative safety and short-term therapeutic effect of laparoscopic pancreaticoduodenectomy and open pancreatoduodenectomy on pancreatic head carcinoma.Methods:1.A total of 184 patients clinical data of pancreatic head carcinoma who underwent pancreaticoduodenectomy were retrospectively analyzed from January 2014 to June 2019 in The First Affiliated Hospital of Hunan Normal University in the Department of Hepatobiliary Surgery.2.All the patients were divided into Laparoscopic Pancreaticoduodenectomy group and Open Pancreaticoduodenectomy group.The two groups’ confounding factors were balanced by matching propensity score.The matched data were analyzed to compare the perioperative results and pathological results.3.The statistical methods such as Kaplan-Meier survival analysis and COX regression analysis were used to analyze the overall survival and prognosis of the patients.Results:1.A total of 133 patients were enrolled after screening.1:1 patient matching was performed by propensity score and 43 patients in OPD group and 43 in LPD group composed the matched cohort.Before matching,the proportion of soft pancreas and the tumor diameter of the two groups were unbalanced and the difference was statistically significant(P<0.05).After matching,the cohorts of 86 patients were well-balanced.2.Perioperative outcomes: Before matching,the LPD group had shorter postoperative hospitalization time and less blood loss than OPD group(P<0.05).After matching,the LPD group still had an advantage over the OPD group in terms of postoperative hospitalization time and blood loss.After matching,the proportions of Level 2 and Level 3 in LPD group were less than OPD group,(9.30% vs 34.88%)and(4.65% vs11.62%),respectively.There was no statistically significant differrencebetween the two groups in operation time,ICU time,reoperation rate,30-day mortality,complications,B/C bleeding,B/C pancreatic fistula,B/C gastric emptying delay and postoperative infection(P>0.05).3.Pathology results:There were no statistically significant differences between the LPD group and the OPD group in tumor T stage,total number of lymph nodes,positive lymph nodes and resection margins in pathological results(P>0.05).4.Postoperative complications: Before matching,the median survival time of LPD and OPD groups were 20.0 and 22.5 months,respectively.There was no statistically significant difference of them(P>0.05).After matching,the difference between two groups was still not statistically significant.Univariate Cox regression analysis showed that postoperative ICU time(HR=2.073,P<0.05),T stage(HR=1.572,P<0.05),reoperation rate(HR=7.035,P<0.05)and systemic mesopancreas dissecton(HR=0.782,P<0.05)were associated with overall survival in the original cohort.Multivariate Cox regression analysis showed that only N stage(HR=2.182,P<0.001)was validated as independent risk factors affecting the overall survival.Conclusion:This study shows that LPD is technically feasible and safe in patients with resectable carcinoma of the head of the pancreas and can achieve considerable long-term survival compared with OPD.Laparoscopic resection of the mesopancreas of pancreas can be performed to obtain R0 resection to achieve the open efficacy,but this technique requires further study.