Abstract:Background and Aims: Pancreaticoduodenectomy (PD) is a complex surgical procedure, which is one of the most difficult procedures in general surgery. With the development of minimally invasive surgical methods, the laparoscopic PD (LPD) has been gradually gaining popularity, and become increasingly mature. This study was conducted to summarize the experience from the authors’ hospital in performing LPD, so as to further improve the efficacy and success rates of this procedure.
Methods: The perioperative clinical data and follow-up results of 73 patients undergoing LPD in the Department of General Surgery, the First Affiliated Hospital of USTC from January 2016 to December 2018 were retrospectively analyzed.
Results: Of the 73 patients, 31 cases were males and 42 cases were females, with an average age of (55.66±11.70) years. The average operative time was (601.3±100.0) min, the average intraoperative blood loss was (448.6±313.3) mL. Postoperative pancreatic fistula occurred in 27 patients (36.9%), including biochemical leakage in 16 cases (21.9%), grade B pancreatic fistula in 6 cases (8.2%) and grade C pancreatic fistula in 5 cases (6.8%); the delayed gastric emptying occurred in 46 patients (63.0%); the postoperative bleeding occurred in 6 patients (8.2%). Four patients (5.4%) underwent postoperative reoperation, and perioperative death occurred in one patient (1.4%). The postoperative pathology diagnosed malignant tumor in 63 patients (86.3%), of whom, 31 cases were cancer of the duodenal papilla, 13 cases were cancer of the lower portion of common bile duct, 14 cases were malignant tumor of the ampulla of Vater, and 5 cases were cancer of the pancreatic head; benign occupying lesion in 10 patients (13.7%), of whom, 6 cases were solid and papillary tumor of the pancreas, 3 cases were mucinous cystadenoma of the pancreas and one case was pancreatic neuroendocrine tumor. Follow-up was performed for 4 to 35 months, with an average of 11.5 month, and no death occurred during this time.
Conclusion: LPD is safe and feasible, the incidence of postoperative complications is within an acceptable level, and it can also meet the standards of radical surgery. With the continuous addition of surgical experience and constant improvement of the laparoscopic devices and apparatus, it can be widely promoted and used.