Comparison of laparoscopic and open pancreaticoduodenectomy for distal cholangiocarcinoma and impact factors on textbook outcome.

BACKGROUND

Distal cholangiocarcinoma (dCCA) is an aggressive malignancy with poor prognosis. This study aimed to compare the short-term and long-term outcomes and "textbook outcome (TO)" between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for dCCA after the learning curve of surgeons.

METHODS

Clinical and follow-up data were included for dCCA patients treated with LPD or OPD at our center between January 2017 and December 2022. The propensity score matching (PSM) method was used to minimize bias between groups. Univariate and multivariate logistic regression analyses were used to determine independent prognostic factors for TO.

RESULTS

A total of 430 patients were enrolled in the study, 224 in the LPD group and 206 in the OPD group. After PSM, 184 patients were included in each group. There were no significant differences in operative duration, lymph nodes harvest, intraoperative transfusion, vascular resection, R0 resection, severe complications, readmission rate, 30-day mortality, TO, and long-term prognosis between the two groups before and after PSM (all P > 0.05). Compared with OPD, LPD had less estimated blood loss (160 vs. 250mL, P < 0.001) and shorter postoperative length of stay (13 vs. 16 days, P < 0.001). Multivariate analysis showed that texture of pancreas [hard vs. soft, Odds Ratio (OR) 2.016; 95% confidence interval (CI) 1.276-3.184; P = 0.003] and operation duration (> 360 min vs. ≤ 360 min, OR 0.595, 95% CI 0.375-0.944, P = 0.027) were independent prognostic factors for TO.

CONCLUSIONS

After learning curve, LPD is safe and feasible for the treatment of dCCA, with the advantages of less intraoperative blood loss and faster postoperative recovery.