Division of Oncologic and Mini-Invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, Italy.
Surg Endosc. 2023 Jan;37(1):759-765. doi: 10.1007/s00464-022-09494-2. Epub 2022 Aug 3.
The most debated aspects of laparoscopic pancreaticoduodenectomy (LPD) concern the dissection of the pancreas from the surrounding vessels and the achievement of adequate resection margins, especially in patients with pancreatic cancer.
Data of consecutive patients undergoing LPD with right artery first approach from September 2020 to September 2021 for periampullary neoplasms (pancreatic, ampullary, duodenal, distal common biliary duct) were prospectively collected and retrospectively analyzed. The overall cohort was divided into two groups: patients affected by pancreatic carcinoma (PC) and patients affected by other periampullary neoplasms (OP). Surgical and postoperative outcomes between PC and OP were compared.
Thirty-one patients (15 PC and 16 OP) were selected. No difference was found between PC and OP in terms of baseline characteristics. Median resection time and overall surgical time of the entire cohort were 275 min and 530 min, respectively, without difference between the groups (p = 0.599 and 0.052, respectively). Blood loss was similar between the groups, being 350 ml in PC and 325 ml in OP (p = 0.762). One patient (3.2%) was converted to laparotomy. No difference was found between the groups in terms of pathological outcomes. Median number of retrieved lymph nodes was 17. The majority of the patients (83.9%) received an R0 resection (73.3% and 93.7% in PC and OP, respectively; p = 0.172). Postoperative surgical outcomes did not differ between the groups, excepting for overall complication rate that was higher in the OP group (26.7% vs 68.7% in PC and OP, respectively; p = 0.032).
Standardized right artery first approach during LPD was feasible and did not show worse surgical and postoperative outcomes in patients with pancreatic cancer as compared to those affected by other periampullary neoplasms, except for a higher rate of minor complications.
腹腔镜胰十二指肠切除术（LPD）最具争议的方面涉及胰腺与周围血管的分离以及获得足够的切缘，尤其是在胰腺癌患者中。
前瞻性收集 2020 年 9 月至 2021 年 9 月期间接受右动脉优先入路 LPD 的连续患者的数据，并进行回顾性分析。将整个队列分为两组：胰腺癌（PC）患者和其他壶腹周围肿瘤（OP）患者。比较 PC 和 OP 患者的手术和术后结果。
共选择了 31 名患者（15 名 PC 和 16 名 OP）。PC 和 OP 患者的基线特征无差异。整个队列的中位切除时间和总手术时间分别为 275 分钟和 530 分钟，两组之间无差异（p=0.599 和 0.052）。两组之间的出血量相似，分别为 350ml 和 325ml（p=0.762）。1 名患者（3.2%）转为开腹手术。两组之间的病理结果无差异。中位淋巴结检出数为 17 枚。大多数患者（83.9%）获得了 R0 切除（PC 组和 OP 组分别为 73.3%和 93.7%；p=0.172）。两组之间的术后手术结果无差异，但 OP 组的总并发症发生率较高（26.7%与 PC 组和 OP 组的 68.7%；p=0.032）。
在 LPD 中标准化右动脉优先入路是可行的，与其他壶腹周围肿瘤患者相比，该方法在胰腺癌患者中并未显示出更差的手术和术后结果，但轻微并发症发生率较高。
