Perioperative Safety And Efficacy Analysis Of Laparoscopy And Open Pancreaticoduodenectomy In The Treatment Of Distal Cholangiocarcinoma

Backgound: There are many comparative studies on the clinical efficacy laparoscopic pancreatoduodenectomy and openpancreatoduodenectomy for the treatment of ampullary tumors at home and abroad,but the efficacy and survival analysis of LPD alone for the treatment of lower common bile duct cancer are still lacking.Objective: To analyze and discuss the perioperative safety and short-term efficacy of laparoscopic pancreaticoduodenectomy for lower bile duct cancer.Methods: Clinical data of 135 patients with lower bile duct cancer from January 2013 to December 2017 were retrospectively analyzed.Results: The operation time of LPD was slightly longer than that of OPD[(334.49 ± 55.24)min than(315.53 ± 55.24)min,P = 0.061],but the difference was not statistically significant.The intraoperative blood loss in the LPD group [(178.37 ± 132.7)ml ratio(312.56 ± 265.9)ml,P =0.001] and hospital stay(25.22 ± 12.7)d ratio(29.72 ± 11.4)d,P = 0.037]were significantly better than OPD.There was no significant difference in tumor characteristics and tumor stage between the two groups.The number of lymph nodes acquired during operation,the positive rate of lymph nodes and the rate of R0 were similar.There was no difference between the laparoscopicopen and open groups in pancreaticfistula(18.4% vs.22.1%,P = 0.608),abdominal infections(12.2% vs.19.8%,P = 0.264),delayed gastric emptying(6.1% vs.10.5%,P = 0.394)or postpancreatectomy haemorrhage(8.2% vs.9.3%,P = 0.823).Overall complications(as defined by the Clavien-Dindo classification)were similar(8.2% to 8.1%,P = 0.996).The 30-day mortality rate and reoperation rate of the two groups after surgery were similar.The 1-year and 3-year overall survival rates of the two groups(85.1% vs.86.2%,40.4% vs.42.8%,P = 0.979)were not statistically different.Conclusion: Laparoscopic pancreaticoduodenectomy is safe and effective for the treatment of lower common bile duct cancer.Compared with OPD,LPD has the advantages of less intraoperative blood loss and shorter hospital stay,and the postoperative overall survival rate is no less than that of open surgery.