Clinical efficacy of three-dimensional laparoscopic pancreaticoduodenectomy

Abstract

Objective To investigate the application value of three-dimensional (3D) laparoscopic pancreaticoduodenectomy (LPD) and compare the clinical outcomes between 3D-LPD and open pancreaticoduo-denectomy (OPD). Methods The retrospective cohort study was adopted. The clinicopathological data of 349 patients who underwent pancreaticoduodenectomy at the Affiliated Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between July 2014 and March 2016 were collected. Of 349 patients, 146 undergoing 3D-LPD were allocated into the 3D group and 203 undergoing OPD were allocated into the OPD group. Observation indicators: (1) surgical situations: operation time, volume of intraoperative blood loss, cases of blood transfusion, number of lymph node dissected, resection margin and vascular resection and reconstruction, (2) postoperative situations: time of gastric tube removal, duration of intensive care unit (ICU) stay, duration of hospital stay, (3) complications: pancreatic fistula, delayed gastric emptying, intra-abdominal infection or abscess, bile leakage, hemorrhage, pulmonary infection or wound infection, (4) follow-up. All the patients were followed up by telephone interview to detect the tumor-free survival rate up to June 2016. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using the t test. Count data were analyzed using the chi-square test. Results (1) Surgical situations: all the patients underwent successful pancreaticoduodenectomy. Operation time, volume of intraoperative blood loss, cases of blood transfusion, number of lymph node dissected and positive resection margin were (334±175)minutes, (254±107)mL, 29, 13±8, 1 in the 3D group and(320±91)minutes, (290±101)mL, 35, 14±9, 5 in the OPD group, respectively, with no statistically significant difference between the 2 groups (t=0.975, 1.383, χ2=0.390, t=12.155, χ2=1.589, P>0.05). Vascular resection and reconstruction were respectively applied to 0 patient in the 3D group and 14 patients in the OPD group, with a statistically significant difference between the 2 groups (χ2=10.490, P 0.05). (4) Follow-up: all the patients were followed up at postoperative month 6. Tumor-free survival rate was 90.41%(132/146) in the 3D group and 85.22%(173/203) in the OPD group, with no statistically significant difference between the 2 groups (χ2=2.076, P>0.05). Conclusion Compared with OPD, 3D-LPD can provide the more realistic visual effects and refinement of surgical procedures, with a good short-term outcome. Key words: Periampullary diseases; Pancreaticoduodenectomy; Complication; Laparoscopy; Three-dimensional technique