Abstract: Objective:To explore the shortterm outcome of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for pancreatic head cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 108 patients with pancreatic head cancer who were admitted to the Affiliated Tongji Hospital of Huazhong University of Science and Technology between July 2014 and July 2015 were collected. Among 108 patients, 47 and 61 who respectively underwent LPD and OPD were allocated into LPD and OPD groups. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological situations; (4) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect chemotherapy and postoperative survival situations at 1 and 3 years postoperatively up to June 2018. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Comparison between groups of count data was analyzed using the chisquare test.
Results:(1) Intraoperative situations: operation time in the LPD and OPD groups was respectively (288±24)minutes and (265±29)minutes, with no statistically significant difference between groups (t=5.138, P>0.05). Volume of intraoperative blood loss in the LPD and OPD groups was respectively (136±14)mL and (388±21)mL, with a statistically significant difference between groups (t= -7.297, P<0.05). Cases with blood transfusion were respectively 3 and 7 in the LPD and OPD groups, with no statistically significant difference between groups (x²=0.325, P>0.05). (2) Postoperative situations: of 47 patients in the LPD group, 16 with postoperative complications were improved by conservative treatment, including 7 with pancreatic fistula (5 with biochemical pancreatic fistula and 2 with grading B and C of pancreatic fistula); 4 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment; 2 with postoperative bleeding were improved by conservative treatment; 2 with intraabdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainage; 1 with biliary fistula was improved by transabdominal percutaneous drainage; there was no wound infection and perioperative death. Of 61 patients in the OPD group, 28 with postoperative complications were improved by conservative treatment, including 12 with pancreatic fistula (9 with biochemical pancreatic fistula and 3 with grading B and C of pancreatic fistula); 8 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment; 3 with intraabdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainage; 2 with postoperative bleeding were improved by conservative treatment; 2 with wound infection were cured by conservative treatment; 1 with biliary fistula was improved by transabdominal percutaneous drainage; there was no perioperative death. There was no statistically significant difference in the cases with postoperative complications between groups (x²=1.546, P>0.05). Duration of hospital stay in the LPD and OPD groups was (13.6±2.1)days and (19.3±4.4)days, respectively, with a statistically significant difference (t=-4.354, P<0.05). (3) Postoperative pathological situations: R0 resection rate was respectively 100.0%(47/47) and 98.4%(60/61) in the LPD and OPD groups, with no statistically significant difference (x²=0, P>0.05), and there was 1 patient with R1 resection in the OPD group. The total number of lymph node dissected in the LPD and OPD groups was respectively 19±4 and 13±4, with a statistically significant difference (t=-4.126, P<0.05). The cases with high and moderatedifferentiated tumor and lowdifferentiated tumor (tumor differentiation), staging T1-T2 and T3-T4 (T stage), staging N0 and N1 (N stage), staging Ⅰ and Ⅱ-Ⅲ (TNM staging) and nerve or vascular invasion were respectively 35, 12, 28, 19, 20, 27, 16, 31, 21 in the LPD group and 50, 11, 36, 25, 36, 25, 14, 47, 32 in the OPD group, with no statistically significant difference (x²=0.891, 0.003, 2.882, 1.628, 0.643, P>0.05). (4) Followup and survival situations: 44 and 55 patients in the LPD and OPD group respectively underwent postoperative adjuvant therapy during the followup, with no statistically significant difference (x²=0, P>0.05). The postoperative 1year followup: 47 patients in the LPD group were followed up, 37 survived and 10 died; of 61 patients in the OPD group, 3 lost to followup, and 58 were followed up (43 survived and 15 died); there was no statistically significant difference in survival between groups (x²=0.301, P>0.05). The postoperative 3year followup: of 47 patients in the LPD group, 3 lost to followup, and 44 were followed up (21 survived and 23 died); of 61 patients in the OPD group, 6 lost to followup, and 55 were followed up (23 survived and 32 died); there was no statistically significant difference in survival between groups (x²=0.346, P>0.05).
Conclusion:LPD is safe and feasible for pancreatic head cancer, with advantages of less bleeding, shorter duration of hospital stay and more total number of lymph node dissected, and its survival effect is equivalent to that of OPD.