Choice of surgical methods and short-term therapeutic efficacy analysis of laparoscopic pancreaticoduodenectomy

Objective To investigate the choice of surgical methods and short-term therapeutic efficacy of laparoscopic pancreaticoduodenectomy. Methods A retrospective analysis was performed on the clinical data of 188 cases who underwent laparoscopic pancreaticoduodenectomy (LPD) from December 2015 to December 2017 in Cangzhou Central Hospital. Total laparoscopic pancreaticoduodenectomy (TLPD) was performed in 102 patients whose diameter of pancreatic duct was greater than or equal to 3 mm, and end-to-side anastomosis of pancreatic duct and jejunum was used to reconstruct the digestive tract (TLPD group). Laparoscopic assisted pancreaticoduodenectomy (LAPD) was performed in 86 patients with pancreatic duct diameter less than 3 mm, and the digestive tract was reconstructed by end-to-side pancreaticoduodenectomy with pocket-insertion (LAPD group). The clinical data of the two groups were analyzed and compared. Results There were no significant differences on sex, age, ASA grade, preoperative total bilirubin, alanine aminotransferase and serum albumin levels between the two groups(P>0.05), which was comparable. The total incision length and hospitalization time in TLPD group were significantly shorter than those in LAPD group [(8.2±1.4)cm vs (12.9±2.6)cm]; [(10.9±5.9)d vs (14.3±6.5)d], while the time of pancreaticojejunostomy was significantly longer than that in LAPD group [(36.1±14.7)min vs (14.0±4.2)min]. The incidence of pancreatic fistula after operation was significantly higher than that in LAPD group (30.4% vs 10.5%). The difference was statistically significant (all P<0.05). There were no significant differences on mean operation time, intraoperative bleeding volume, number of lymph node dissection, R0 resection rate, ICU admission time, eating time, total complication rate and 6-month disease-free survival rate between the two groups. Conclusions TLPD has the advantages of less trauma and quicker recovery. But for pancreatic duct diameter less than 3 mm, the choice of LAPD can increase the safety of operation and reduce the incidence of postoperative pancreatic fistula. Key words: Pancreaticoduodenectomy; Laparoscopy; Pancreatic fistula