Abstract:

Objective

To study the clinical influence of the modified retroperitoneal-priority in situ laparoscopic pancreatoduodenectomy (LPD) on regional lymph node dissection and postoperative complications.

Methods

A total of 66 patients with periampullary carcinoma admitted from January 2021 to December 2023 were prospectively selected as the research subjects, and all patients underwent LPD. They were divided into a modified group and a reference group by the random number table method, with 33 cases in each group. The modified group adopted the modified retroperitoneal-priority in situ LPD (MPPLPD), and the reference group adopted the conventional venous approach LPD. The statistical software SPSS24.0 was used for data analysis.Measurement data such as the operation time and the total number of dissected lymph nodes were expressed as(), and an independent sample t test was performed; Rank sum test was adopted for rank data such as ASA classification; Count data were expressed as percentages, and a chi-square test was performed. The survival curve was drawn by the Kaplan-Meier method, and the survival status of the patients was examined by the Log-Rank test.

Results

All patients underwent R0 resection, and there was no case converted to open surgery.There were no statistically significant differences in the number of positive lymph nodes dissected, the time to start eating, the time to exhaust, and the length of hospital stay between the two groups (P>0.05). Compared with the reference group, the operation time in the modified group was shorter, the intraoperative blood loss was less, and the total number of dissected lymph nodes was larger (P<0.05). In the modified group, there were 3 cases of Clavien-Dindo grade I, 3 cases of grade II, and 2 cases above grade III, which were lower than 7 cases of grade I, 10 cases of grade II, and 5 cases above grade III in the reference group (P<0.05), and the incidence of postoperative bleeding in the modified group was significantly lower than that in the reference group (6.1%vs. 24.2%, P<0.05). From 3 to 45 months after surgery, there was no statistically significant difference in the overall survival rate between the two groups (P>0.05), and the disease-free survival rate of the modified group was higher than that of the reference group (84.8% vs. 63.6%, Log-Rank χ²=9.643, P<0.05).

Conclusion

Compared with the standard venous-first approach LPD, the modified retroperitoneal-priority in situ LPD can increase the total number of dissected lymph nodes, reduce the risk of postoperative complications and bleeding,enhance the surgical safety, and reduce the possibility of disease recurrence.

Key words: Periampullary Carcinoma, Laparoscopic Pancreaticoduodenectomy, Modified Peritoneal Priority, Arterial Approach