Applicaition value of standardized Ω‑approach laparoscopic pancreaticoduodenectomy for periampullary tumors

Objective To investigate the application value of standardized Ω‑approach lapa-roscopic pancreaticoduodenectomy (LPD) for periampullary tumors.

Methods The retrospective cohort study was conducted. The clinicopathological data of 391 patients with periampullary tumors who were admitted to Zhengzhou University People′s Hospital from August 2018 to August 2024 were collected. There were 230 males and 161 females, aged (59±10) years. Of the 391 patients, 316 patients undergoing traditional approach LPD were set as the traditional resection group, and 75 patients undergoing standardized Ω‑approach LPD were set as the standardized resection group. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow‑up. 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 chi‑square test. The Kaplan‑Meier method was used to calculate survival rates and draw survival curves, and the Log‑rank test was used for survival analysis.

Results (1) Intra-operative conditions: for patients in the traditional resection group, the volume of intraoperative bold loss was (133±100) mL, the operation time was (260±76) minutes, and the number of lymph node dissected was 15±5. For patients in the standardized resection group, the above indicators was (105±91) mL, (235±83) minutes, and 18±3. There were significant differences in the above indicators between the two groups (t=2.22, 2.50, -20.48, P<0.05). (2) Postoperative conditions: for patients in the traditional resection group, cases with postoperative grade B‑C pancreatic fistula was 83 and the duration of postoperative hospital stay was (16.0±4.0) days. For patients in the standardized resection group, the above indicators was 10 and (14.7±2.5) days. There were significant differences in the above indicators between the two groups (χ²=5.59, t=3.25, P<0.05). (3) Follow‑up: all 391 patients were followed up for 31(range, 1-60) months. For patients in the traditional resection group, the postoperative median overall survival time was 31(12,48) months, the postoperative 1‑, 2‑, 3‑year survival rates were 68.4%, 55.4%, 47.2%, respectively. For patients in the standardized resection group, the postoperative median overall survival time was 34(10,49) months, the postoperative 1‑, 2‑, 3‑year survival rates were 69.3%, 56.0%, 49.3%, respectively. There was no significant difference in the postoperative overall survival between the two groups (χ²=0.27, P>0.05).

Conclusions Compared with traditional approach LPD, standardized Ω‑approach LPD for the treatment of periampullary tumors has advantages such as less volume of intraoperative blood loss, shorter operation time and duration of postoperative hospital stay, the larger number of lymph node dissected, and a lower proportion of postoperative grade B-C pancreatic fistula. It holds potential for clinical application.