Abstract: Objective:To investigate the application value of threedimensional (3D) laparoscopic pancreaticoduodenectomy (LPD) and compare the clinical outcomes between 3DLPD and open pancreaticoduo denectomy (OPD).
Methods:The retrospective cohort study was adopted. The clinicopathological data of 349 〖HQK〗patients who underwent pancreaticoduodenectomy at the Affiliated Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between July 2014 and March 2016 were collected. Of 349 patients, 146 undergoing 3DLPD were allocated into the 3D group and 203 undergoing OPD were allocated into the OPD group. Observation indicators: (1) surgical situations: operation time, volume of intraoperative blood loss, cases of blood transfusion, number of lymph node dissected, resection margin and vascular resection and reconstruction, (2) postoperative situations: time of gastric tube removal, duration of intensive care unit (ICU) stay, duration of hospital stay, (3) complications: pancreatic fistula, delayed gastric emptying, intraabdominal infection or abscess, bile leakage, hemorrhage, pulmonary infection or wound infection, (4) followup. All the patients were followed up by telephone interview to detect the tumorfree survival rate up to June 2016. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using the t test. Count data were analyzed using the chisquare test.
Results:(1) Surgical situations: all the patients underwent successful pancreaticoduodenectomy. Operation time, volume of intraoperative blood loss, cases of blood transfusion, number of lymph node dissected and positive resection margin were (334±175)minutes, (254±107)mL, 29, 13±8, 1 in the 3D group and(320±91)minutes, (290±101)mL, 35, 14±9, 5 in the OPD group, respectively, with no statistically significant difference between the 2 groups (t=0.975, 1.383, χ²= 0.390, t=12.155, χ²=1.589, P>0.05). Vascular resection and reconstruction were respectively applied to 0 patient in the 3D group and 14 patients in the OPD group, with a statistically significant difference between the 2 groups (χ²=10.490, P<0.05). (2) Postoperative situations: time of gastric tube removal, duration of ICU stay and duration of hospital stay were (2.9±1.9)days, (6.9±2.1)days, (12.9±7.2)days in the 3D group and (5.1±1.7)days, (7.4±1.2)days, (19.8±7.1)days in the OPD group, respectively, with statistically significant differences between the 2 groups (t=11.350, 2.814, 8.903, P<0.05). (3) Complications: of 146 patients in the 3D group, 40 had postoperative complications with incidence of complications of 27.40% (40/146). Twentynine patients with pancreatic fistula (20 in grade A, 9 in grade B and C) were improved by conservative treatment. Thirteen patients with delayed gastric emptying were cured by gastrointestinal decompression and enhancing gastric motility. Of 5 patients with postoperative hemorrhage, 3 were improved by conservative treatment, and 2 were improved by small vein hemostasis behind the head of pancreas. One patient died of systemic inflammatory response syndrome. Partial patients were combined with multiple complications. Of 203 patients in the OPD group, 60 had postoperative complications with incidence of complications of 29.56% (60/203), including 39 patients with pancreatic fistula (31 in grade A, 8 in grade B and C), 25 with delayed gastric emptying, 15 with intraabdominal infection and 13 with systemic inflammatory response syndrome, and they were improved by conservative treatment. Of 8 patients with postoperative hemorrhage, 4 were improved by conservative treatment, and 4 were cured by hemostatic therapy after ineffectual blood transfusion and interventional treatment. Two patients died of cardiopulmonary complication. Partial patients were combined with multiple complications.There was no statistically significant difference in the incidence of postoperative complication between the 2 groups (χ²=10.490, P>0.05). (4) Followup: all the patients were followed up at postoperative month 6. Tumorfree survival rate was 90.41%(132/146) in the 3D group and 85.22%(173/203) in the OPD group, with no statistically significant difference between the 2 groups (χ²=2.076, P>0.05).
Conclusion:Compared with OPD, 3DLPD can provide the more realistic visual effects and refinement of surgical procedures, with a good shortterm outcome.