Perioperative safety and efficacy of laparoscopic pancreaticoduodenectomy for carcinoma of the lower common bile duct

doi:10.3877/cma.j.issn.1674-3946.2022.02.019

Abstract

Abstract:

Objective

To investigate the safety and efficacy of laparoscopic pancreaticoduodenectomy（LPD）in the treatment of the lower common bile duct carcinoma.

Methods

Data of 97 patients who underwent pancreaticoduodenectomy（PD）for lower common bile duct carcinoma from January 2015 to December 2019 were retrospectively analyzed. Among them，56 patients undergoing laparoscopic assist pancreaticoduodenectomy were included in the LAPD group，and 41 patients undergoing LPD were included in the LPD group. Data were analyzed by SPSS 24.0 statistical software. Perioperative indexes and other measurement data were expressed as（

x ˉ

±s），and independent sample t test was performed. Postoperative complications were tested by χ² test. Kaplan-Meier survival curve was used for survival analysis. P<0.05 was taken as the test standard.

Results

Compared with the LPD group，the operation time and digestive tract reconstruction time of the LAPD group were shorter，while the intraoperative blood loss was more than that of the LPD group，and the postoperative exhaust time was longer，with statistical significance between the two groups（P<0.05）. There were no significant differences in the length of hospital stay，number of lymph nodes dissected and postoperative complications between two groups（P>0.05）.All patients were successfully followed up for 12~59 months，with a median follow-up time of 26 months. The 1-year overall survival rate（OS）was 87.3% and 87.6%，and the 3 years OS was 46.6% and 41.2%，respectively，with no statistical significance between the two groups（P>0.05）.

Conclusion

LPD is safe and feasible in the treatment of carcinoma of the lower common bile duct. Compared with LAPD，LPD has the advantages of less trauma and faster postoperative recovery. However，it is difficult to operate，and the operators should practice it after strict training and learning to ensure the safety and effectiveness of the operation.

Key words: Carcinoma of the lower common bile duct, Pancreatoduodenectomy, Laparoscope, Laparoscopic assist, Security

Donghua Pan, Guiquan Li, Yuting Wu, Xian Liu, Jianmei Luo, Shanshan He, Jinqiang Fu. Perioperative safety and efficacy of laparoscopic pancreaticoduodenectomy for carcinoma of the lower common bile duct[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 187-191.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.02.019

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2022/V16/I02/187

Figures/Tables 4

References 15

[1]	中国抗癌协会. 远端胆管癌规范化诊治专家共识（2017）［J］. 中华肝胆外科杂志，2018，24（1）：1-8.
[2]	De Rooij T,，Lu MZ,，Steen MW，et al. Minimally Invasive Versus Open Pancreatoduodenectomy：Systematic Review and Meta-analysis of Comparative Cohort and Registry Studies［J］. Ann Surg，2016，264（2）：257-267.
[3]	Beetz O,，Klein M,，Schrem H，et al. Relevant prognostic factors influencing outcome of patients after surgical resection of distal cholangiocarcinoma［J］. BMC Surg，2018，18（1）：56.
[4]	周叶明，陆才德，朱宏达，等. 胆总管下段癌行根治性胰十二指肠切除术23例临床分析［J］. 现代实用医学，2019，31（8）：1073-1075.
[5]	李方平，熊彬，龚建平. 胰十二指肠切除术后主要并发症的诊断与治疗进展［J］. 国际外科学杂志，2018，45（5）：341-344.
[6]	耿炜，彭金茹，赵雪琪，等. 加速康复外科模式对腹腔镜下胰十二指肠切除术后患者肠道黏膜屏障影响的研究［J/CD］. 中华普外科手术学杂志（电子版），2020，14（3）：260-263.
[7]	Palanivelu C,，Senthilnathan P,，Sabnis SC，et al. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours［J］. Br J Surg，2017，104（11）：1443-1450.
[8]	Kang CM,，Lee WJ. Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma？［J］. Cancers，2020，12（11）：3430.
[9]	Wang M,，Peng B,，Liu J，et al. Practice Patterns and Perioperative Outcomes of Laparoscopic Pancreaticoduodenectomy in China：A Retrospective Multicenter Analysis of 1029 Patients［J］. Ann Surg，2021，273（1）：145-153.
[10]	姜宁，王宏. 改良胰肠吻合方式对胰十二指肠切除术后患者胰瘘的影响及影响因素分析［J/CD］. 中华普外科手术学杂志（电子版），2019，13（3）：262-265.
[11]	尹杰，陆子鹏，张凯，等. 492例胰十二指肠切除术后胃排空延迟的预后因素分析［J］. 中华外科杂志，2018，56（1）：35-40.
[12]	Komaya K,，Ebata T,，Shirai K，et al. Recurrence after resection with curative intent for distal cholangiocarcinoma［J］. Br J Surg，2017，104（4）：426-433.
[13]	洪德飞. 腹腔镜与达芬奇机器人胰十二指肠切除术进展［J］. 浙江医学，2018，40（19）：2093-2096.
[14]	Nassour I,，Wang SC,，Christie A，et al. Minimally Invasive Versus Open Pancreaticoduodenectomy：A Propensity-matched Study From a National Cohort of Patients［J］. Ann Surg，2018，268（1）：151-157.
[15]	胡仁健，秦红军，程刚，等. 腹腔镜下胰十二指肠切除术36例［J］. 武警医学，2019，30（8）：709-711.

组别	例	性别		年龄（岁）	ASA分级
组别	例	男	女	年龄（岁）	Ⅰ	Ⅱ	Ⅲ
LAPD组	56	33	23	56.4±6.1	22	26	8
LPD组	41	29	12	55.2±5.8	16	20	5
t/χ²	-	1.429		0.977	0.105
P	-	0.231		0.165	0.948
组别	例	BMI（kg/m²）	肿瘤直径（cm）	TNM分期
组别	例	BMI（kg/m²）	肿瘤直径（cm）	T₁	T₂	T₃
LAPD组	56	23.3±2.4	2.4±0.6	29	18	9
LPD组	41	23.1±2.7	2.5±0.5	21	14	6
t/χ²	-	0.384	0.868	0.061
P	-	0.350	0.193	0.969

组别	例	性别		年龄（岁）	ASA分级
组别	例	男	女	年龄（岁）	Ⅰ	Ⅱ	Ⅲ
LAPD组	56	33	23	56.4±6.1	22	26	8
LPD组	41	29	12	55.2±5.8	16	20	5
t/χ²	-	1.429		0.977	0.105
P	-	0.231		0.165	0.948
组别	例	BMI（kg/m²）	肿瘤直径（cm）	TNM分期
组别	例	BMI（kg/m²）	肿瘤直径（cm）	T₁	T₂	T₃
LAPD组	56	23.3±2.4	2.4±0.6	29	18	9
LPD组	41	23.1±2.7	2.5±0.5	21	14	6
t/χ²	-	0.384	0.868	0.061
P	-	0.350	0.193	0.969

组别	例	手术时间（min）	术中出血量（ml）	消化道重建时间（min）
LAPD组	56	317.6±56.4	186.7±81.3	42.6±5.5
LPD组	41	339.7±72.3	160.6±68.4	45.8±6.2
t/χ²	-	1.691	1.667	2.681
P	-	0.047	0.049	0.004
组别	例	术后排气时间（d）	住院时间（d）	淋巴结清扫数目（枚）
LAPD组	56	2.9±0.4	18.1±5.5	17.4±1.0
LPD组	41	2.7±0.3	17.6±5.2	17.6±1.2
t/χ²	-	2.693	0.452	0.893
P	-	0.004	0.325	0.186

组别	例	手术时间（min）	术中出血量（ml）	消化道重建时间（min）
LAPD组	56	317.6±56.4	186.7±81.3	42.6±5.5
LPD组	41	339.7±72.3	160.6±68.4	45.8±6.2
t/χ²	-	1.691	1.667	2.681
P	-	0.047	0.049	0.004
组别	例	术后排气时间（d）	住院时间（d）	淋巴结清扫数目（枚）
LAPD组	56	2.9±0.4	18.1±5.5	17.4±1.0
LPD组	41	2.7±0.3	17.6±5.2	17.6±1.2
t/χ²	-	2.693	0.452	0.893
P	-	0.004	0.325	0.186

组别	例	胰瘘			胆瘘
组别	例	生化漏	B级	C级	胆瘘
LAPD组	56	6	3	0	2
LPD组	41	7	3/	1	3
χ²	-	0.824	0.156	-	0.129
P	-	0.363	0.692	1	0.719
组别	例	腹腔感染	肺部感染	胃排空延迟	术后出血
LAPD组	56	3	4	2	3
LPD组	41	1	2	3	3
χ²	-	0.038	0.209	0.129	0.156
P	-	0.843	0.647	0.719	0.692

Please choose a citation manager

Content to export