Efficacy of laparoscopic pancreaticoduodenectomy at Henan University People’s Hospital: a review of 199 cases

Abstract

Abstract Background: Laparoscopic pancreaticoduodenectomy (LPD) is a difficult and complex surgical operation. Here, we review and analyze 199 cases of LPD performed at Henan University People’s Hospital and summarize the hospital team's experience. Methods: Data related to 199 cases of LPD performed from January 1, 2017 to May 30, 2022 at the Henan University People's Hospital were collected and analyzed to define possible challenges and then used to propose potential solutions. The patients underwent operation using the “Kocher’s incision, caudal approach, and uncinate process first” approach for specimen removal followed by pancreaticojejunostomy using “Zhongyuan three-stitch method”. Results: Our analysis showed that the average age of the patients was 58.4±11.1 years. The data showed that the operative time was 476.2 ± 95.9 minutes, intraoperative bleeding was 200 (200, 400) ml while intraoperative blood transfusion was 0 (0, 1200) ml. Further analysis showed that vascular resection and reconstruction was performed in 1 case (0.5%) for portal vein resection with end-to-end anastomosis. The duration of postoperative hospital stay was 17 (13, 24) days. A total of 71 (35.7%) cases had complications after surgery, 47 (23.6%) had pancreatic fistulas, including 19 (9.5%) grade A, 18 (9.0%) grade B, and 10 (5.0%) grade C fistulas while 30 (15.1%) were lost to follow-up. Ten (6.0%) cases experienced perioperative deaths, where a 1-, 3- and 5-year survival rate was 85.3%, 61.0% and 58.1%, respectively. Furthermore, our data demonstrated that the older the patient, the shorter the postoperative survival time (HR=1.049,95%CI 1.016~1.082，P=0.003) and the higher the CA199, the shorter the survival time (HR=1.000162,95%CI 1.000034~1.000290，P=0.013). Patients who underwent revascularization had a better survival rate (HR=0.117, 95%CI 0.015~0.866，P=0.038); adenocarcinoma of duodenum (74,37.2%), holangiocarcinoma (43,21.6%) and pancreatic cancer (29,14.6%) had significantly different long-term survival rates (c2=6.567,P=0.038). Conclusions: Taken together, our analysis showed that although LPD is a complex and challenging technique, it is an effective and safe procedure as long as the operator solves the challenges during the procedure (such as the " Kocher’s incision, caudal approach, and uncinate process first " approach and the " Zhongyuan three-stitch method").