Clinical efficacy of " Easy First" strategy in laparoscopic pancreaticoduodenectomy for borderline resectable pancreatic cancer

Objective To investigate clinical efficacy of Easy Firststrategy in laparoscopic pancreaticoduodenectomy (PD) for borderline resectable pancreatic cancer. Methods The clinical data of 9 patients with borderline resectable pancreatic cancer who were admitted to the Sir Run Run Shaw Hospital of Zhejiang University (8 patients) and Zhejiang Provincial People's Hospital (1 patient) from June 2013 to March 2015 were retrospectively analyzed. Nine patients underwent laparoscopic pancreaticoduodenectomy based on the Easy Firststrategy (to sequentially dissect and amputate jejunum, stomach, hepatoduodenal ligament, common bile duct, main portal vein, head of pancreas, second segment and third segment of the duodenum, uncinate process and neck of pancreas). The operation time, volume of intraoperative blood loss, postoperative pathological examination, complications and duration of hospital stay were recorded. Patients were followed up once every 3 months by outpatient examination and telephone interview up to June 2015. Results Of 9 patients, 4 received totally laparoscopic PD (2 received partial resection and repair of portal venous wall) , 1 received laparoscopic assisted resection and digestive tract reconstruction, and 4 received laparoscopic transection of jejunum, bile tract and stomach and conversion to open surgery for resection and digestive tract reconstruction (1 with severe adhesion between tumor and portal vein, 3 with bleeding due to dissection of neck and unciform process of pancreas) .The operation time and volume of intraoperative blood loss in all patients and in 4 patients with totally laparoscopic PD were (404±49) minutes and (456 ±348) mL, (395 ± 61) minutes and (188 ± 25) mL, respectively.Of 9 patients, 5 with postoperative complications were cured without perioperative death, including 2 with Grade B pancreatic fistula, 1 with biliary leakage, 1 receiving reoperation due to gastric stump bleeding at postoperative day 7 and 1 with abdominal infection.The extubation time of right drainage tube and left drainage tube was (9 ±5) days and (11 ± 4) days, respectively.The duration of hospital stay was (24 ± 10) days.All patients were diagnosed as with pancreatic cancer by pathological examinations with the tumor diameter of (3.2 ±0.8) cm.The number of harvested lymph nodes in all patients and in 4 patients with totally laparoscopic PD were 16.8 (range, 6.0-25.0) and 19.8 (range, 15.0-25.0) .All the patients were followed up for mean time of 12 months (range, 4-24 months) , including 1 death at postoperative month 3, 1 with tumor survival of 20 months and others with tumor-free survival.The postoperative survival time of 4 patients was more than 18 months at the end of follow-up. Conclusion Easy Firststrategy in laparoscopic PD is safe, feasible and practical for borderline resectable pancreatic cancer. Key words: Pancreatic neoplasms; Borderline resection; Pancreaticoduodenectomy; Laparoscopy