Abstract: Objective:To investigate the safety of the laparoscopic pancreaticoduodenectomy (LPD) in 70 years of age or older patients.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 40 patients (age ≥70 years old) who underwent pancreaticoduodenectomy in the West China Hospital of Sichuan University between January 2012 and December 2016 were collected. Twenty patients undergoing LPD were allocated into the LPD group, and 20 receiving open pancreaticoduodenectomy (OPD) who were selected by random number table during the same period were allocated into the OPD group. Observation indicators included: (1) intraoperative situations; (2) postoperative situations; (3) followup situation. Followup using outpatient examination and telephone interview was performed to detect the patients′ survival after discharge and tumor recurrence and metastasis up to March 2017. Measurement data with normal distribution was represented as ±s, and comparison between groups were evaluated with the t test. Measurement data with skewed distribution were described as median (range) and comparison between groups was analyzed using the nonparametric test. Comparison of count data was analyzed using the chisquare test. Comparison of ranked data was analyzed by non parametric test.
Results:(1) Intraoperative situations: 1 patient in the LPD group was converted to open surgery, with a conversive rate of 5.0%(1/20). Operative time and volume of intraoperative blood loss were (463± 10)minutes, 210.5 mL (152.5-300.0 mL) in the LPD group and (332±25)minutes, 420.0 mL (350.1- 493.8 mL) in the OPD group, showing statistically significant differences between the 2 groups (t=5.48, Z= -3.98, P<0.05). Cases with intraoperative blood transfusion and pylorus preservation were respectively 4, 14 in the LPD group and 6, 10 in the OPD group, showing no statistically significant difference between the 2 groups (x²=0.53, 1.67, P>0.05).The results of intraoperative rapid frozen pathological examination showed negative margin of the 40 patients. (2) Postoperative situations: cases in ICU, cases with postoperative analgesia, time for outofbed activity, time to anal exsufflation and time for intake were 17, 7, (2.2±0.7)days, (4.2±0.9)days, (4.8±0.7)days in the LPD group and 6, 15, (3.6±0.8)days, (5.7±0.9)days, (7.1±2.7)days in the OPD group, showing statistically significant differences between the 2 groups (x²=12.34, 6.47, t= -6.18,-6.55, -3.65, P<0.05). Pancreatic fistula, delayed gastric emptying(Grade B), postoperative bleeding(Grade B), biliary fistula, pulmonary infection, intestinal obstruction, wound infection, reoperation and major complication were respectively detected in 2, 3, 1, 1, 3, 1, 0, 2, 3 patients of the LPD group and 2, 4, 1, 1, 4, 1, 2, 3 ,4 in patients of the OPD group, showing no statistically significant difference between the 2 groups (x²=0.00, 0.17, 0.00, 0.00, 0.17, 0.00, 2.11, 0.23, 0.17, P>0.05). Results of postoperative pathological examination showed that duodenal adenocarcinoma, ampullary carcinoma, lower bile duct carcinoma, pancreatic ductal adenocarcinoma and pancreatic cystic tumor were respectively detected in 8, 2, 5, 3, 2 patients of the LPD group and 10, 2, 4, 2, 2 patients of the OPD group,showing no statistically significant difference between the 2 groups (x²=0.53, P>0.05). Duration of postoperative hospital stay in the LPD and OPD groups were (19±13)days and (15±7)days, respectively, showing no statistically significant difference between the 2 groups (t=1.28, P>0.05). Results of postoperative oncology showed that tumor diameter, number of lymph node dissected, number of positive lymph nodes, cases with negative margin, cases in T1N0M0, T2N0M0, T3N0M0, T3N1M0, T4N0M0, T4N1M0 of TNM staging were respectively (2.4±0.7)cm, 15.4±2.3, 2, 20, 2, 7, 8 ,2, 1, 0 in the LPD group and (2.8±0.9)cm, 14.4±2.5, 3, 20, 1, 8, 5, 2, 3, 1 in the OPD group, with no statistically significant difference between the 2 groups (t=-1.64, 1.32, x²=0.23, 0.00, Z=-0.69, P>0.05). (3) Followup situation: 1 patient died respectively in both groups within the postoperative 30 days. Thirtyeight patients were followed up for 1-26 months, with a median time of 14 months. During followup, 2 patients had tumor recurrence and 1 died of myocardial infarction in the LPD group; 3 had tumor recurrence and 1 died of tumor recurrence in the OPD group.
Conclusion:LPD in 70 years of age or older patients is not only safe and feasible, but also significantly reduce volume of intraoperative blood loss and demand of analgesia, as well as quickly resume normal diet and activities.