Laparoscopic pancreaticoduodenectomy for patients with pancreatic head cancer: an analysis of 57 patients

Objective To study the feasibility of laparoscopic pancreaticoduodenectomy (LPD) in the treatment of pancreatic head cancer, and to analyze the short-term postoperative outcomes. Methods The clinical data of 57 patients with pancreatic head cancer who underwent laparoscopic pancreaticoduodenectomy from April 2015 to November 2017 in the Second Hospital of Hebei Medical University were retrospectively analyzed. Results Of the 57 patients, conversion to open surgery was required in 2 patients, and major venous resection and reconstruction were performed in 9 patients, including 8 end-to-end anastomosis, and 1 synthetic graft interposition. Total pancreatectomy was carried out in 4 patients. For the remaining 53 patients, pancreaticojejunal mucosal anastomoses were carried out in 50 patients, and sleeve pancreaticojejunostomy in 3 patients. The mean operative time and operative blood loss were 497 (240~720) min and 435 (50~3 000) ml, respectively. The mean postoperative hospital stay was 17.7 (6.0~59.0) days. Postoperative complications were detected in 26.3% (15/57) of patients, which included delayed gastric emptying (DGE) in 4 patients, Grade B pancreatic fistula (PF) in 4 patients, biliary fistula (BF) in 2 patients, postpancreatectomy hemorrhage (PPH) in 2 patients, intraabdominal infection in 1 patient and pulmonary infection in 2 patients. All the patients with DGE recovered with conservative treatment and they were discharged home. Reoperation was only required in the two patients with PPH. One patient died after the operation. The postoperative pathological results revealed pancreatic duct adenocarcinoma in 53 patients, adenosscale carcinoma in 1 patient and neuroendocrine carcinoma in 3 patients. The maximum and minimum tumor sizes were 7.0 cm×5.0 cm×3.5 cm and 2.5 cm×1.5×1.0 cm, respectively. The mean lymph nodes harvest and positive lymph node retrieval were 14(1~60) and 0.7(0~3), respectively. Negative resection margins were obtained in 84.2%(48/57) of patients. This study was censored on December 31, 2017. The follow-up for these patients ranged between 1 to 32 months. Mortality occurred in 21 patients, including 1 patient with a ruptured aneurysm 2 months after operation, 2 patients with GI bleeding 2 and 9 months respectively after operation, 1 patient with severe pulmonary infection and 17 patients with cancer recurrence with survival varying from 2 to 21 months. 35 patients were still alive. Conclusion Laparoscopic pancreaticoduodenectomy is a safe and feasible procedure for pancreatic head cancer. Key words: Pancreaticoduodenectomy; Laparoscopes; Pancreas head neoplasms; Treatment outcome