Clinical efficacy of modular laparoscopic pancreaticoduodenectomy via infracolic approach

Objective To investigate the clinical efficacy of modular laparoscopic pancrea-ticoduodenectomy (LPD) via infracolic approach.

Methods The propensity score matching and retros-pective cohort study was conducted. The clinicopathological data of 279 patients who underwent LPD at Tianjin Medical University Cancer Institute & Hospital from January 2024 to September 2025 were collected. There were 122 males and 157 females, aged 63(56, 68) years. Of 279 patients, 120 cases undergoing modular LPD via infracolic approach were allocated into observation group, 159 cases undergoing LPD via traditional venous approach were allocated into control group. Obser-vation indicators: (1) propensity score matching and comparison of clinicopathological characteris-tics of patients between the two groups after matching; (2) surgical and postoperative situations. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi‑square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Propensity score matching was performed with the 1∶1 nearest neighbor matching method, with a caliper value of 0.02.

Results (1) Propensity score matching and comparison of clinicopathological characteristics of patients between the two groups after matching: of the 279 patients, 240 cases were successfully matched, with 120 cases in the observation group and 120 cases in the control group. After propensity score matching, the elimination of age, pre-operative percutaneous transhepatic cholangial drainage for jaundice reduction, and pathological type confounding bias ensured comparability. (2) Surgical and postoperative situations: the operation time, volume of intraoperative blood loss, cases with intraoperative transfusion, cases with conversion to open surgery, the number of lymph node dissected were 160.0(150.0,187.5) minutes, 200(150,200) mL, 5, 5, 20(13,25) for the observation group, versus 190.0(160.0,210.0) minutes, 200(100,300) mL, 16, 14, 13(10,18) for the control group, showing significant differences in above indicators between the two groups (Z=-5.97, -2.41, χ²=6.31, 4.63, Z=-5.75, P<0.05). There was no significant difference in portal vein‑superior mesenteric vein resection and reconstruction, pancreaticojejunos-tomy method, the number of metastatic lymph nodes, postoperative complications, duration of post-operative hospital stay, or 30‑day readmission rate after discharge between the two groups (P>0.05).

Conclusions The modular LPD via infracolic approach is safe and feasible. Compared with the conventional venous approach, it optimizes the surgical procedure of LPD.