ABSTRACT
Objective To explore the short-term 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) follow-up and survival situations.Follow-up 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 x±s and comparison between groups was analyzed using the t test.Comparison between groups of count data was analyzed using the chi-square 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 iu 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 drainagc;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 intra-abdominal 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 c ured 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 moderate-differentiated tumor and low-differentiated 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) Follow-up and survival situations:44 and 55 patients in the LPD and OPD group respectively underwent postoperative adjuvant therapy during the follow-up,with no statistically significant difference (x2=0,P＞0.05).The postoperative 1-year follow-up:47 patients in the LPD group were followed up,37 survived and 10 died;of 61 patients in the OPD group,3 lost to follow-up,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 3-year follow-up:of 47 patients in the LPD group,3 lost to follow-up,and 44 were followed up (21 survived and 23 died);of 61 patients in the OPD group,6 lost to follow-up,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.
ABSTRACT
Objective@#To semi-quantify the postoperative complications occurred after laparoscopic pancreaticoduodenectomy(LPD) using Clavien-Dindo score, thereafter exploring its impact factors.@*Methods@#In this retrospective cohort study, the clinical data of 124 patients who had undergone LPD for periampullary tumor from June 2016 to June 2017 at Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected.Malignancy was confirmed based on postoperative pathological reports.Postoperative complications were semi-quantitated using Clavien-Dindo score.Multivariable logistic regression model was applied to explore the factors related to severe complications(Clavien-Dindo Ⅲb-Ⅴ).@*Results@#Of the 124 patients, there were 64 males(51.6%) and 60 females(48.4%), with age of 57 years(range, 23-82 years). In total, postoperative complications occurred in 30 patients(24.2%). Among the 30 patients, 4 patients suffered Clavien-Dindo grade Ⅰ, 18 patients(14.5%) suffered Clavien-Dindo grade Ⅱ, 6 patients(4.8%) suffered Clavien-Dindo grade Ⅲa, 1 patient(0.1%) suffered Clavien-Dindo grade Ⅳb, and 1 patient(0.1%) suffered Clavien-Dindo grade Ⅴ.Intraabdominal hemorrhage occurred in 8 patients, pancreatic fistula was found in 10 patients(7 patients had biochemical leakage and 3 of them had grade B pancreatic fistula), both biliary fistula and gastrointestinal fistula were found in 1 patient.Abdominal infection occurred in 10 patients, both liver failure and renal failure occurred in one patient.Moreover, arrhythmia was found in two patients, and mortality occurred in one patient.Five patients suffered multiple complications.Univariable analysis showed that postoperative complications were associated with body mass index, American Society of Anesthesiologists(ASA) score, intraoperative blood transfusion, and pancreatic texture(P<0.05). In multivariable logistic regression, ASA grade Ⅲ, intraoperative blood transfusion, and pancreatic softness were independently related to postoperative complications after LPD(P<0.05).@*Conclusions@#Clavien-Dindo score is feasible to be applied in management of patients with LPD.ASA score, texture of pancreas, and intraoperative blood transfusion were independently associated with postoperative complications.