Comparison Of Perioperative And Prognostic Outcomes Of Laparoscopic And Open Pancreatoduodenectomy For Distal Cholangiocarcinoma

Background:Distal cholangiocarcinoma(DCC)is a malignant tumor originating from bile duct epithelium and located between the ampullae of the liver and pancreas(Vater ampullae)and the conjunction of the cystic duct and hepatic duct.According to published studies,DCC accounts for about 20%to 40%of all extrahepatic cholangiocarcinoma cases.Radical pancreatoduodenectomy(PD)is the only surgical option for resectable DCC.With the development of laparoscopic technology in abdominal surgery,laparoscopic pancreatoduodenectomy(LPD)has been widely carried out in major centers in recent years.Thanks to the improvement of surgical techniques and postoperative nursing in recent years,the safety has been significantly improved,and the postoperative complications of LPD have decreased.However,even in high-volume centers,The incidence of postoperative complications of LPD,such as bleeding,pancreatic fistula and bile leakage,is still very high,which can endanger the life of patients in severe cases.Objective:By reviewing and analyzing the perioperative and follow-up results of patients with DCC who received LPD and open pancreaticoduodenectomy(OPD)in our center,and comparing the short-term and long-term oncology results of patients with DCC who received LPD or traditional OPD,this paper sought to investigate the feasibility and safety of LPD.Methods:The preoperative,intraoperative and postoperative information of patients with DCC who received PD in the second Department of Hepatobiliary Surgery for Organ Transplantation in Shandong Provincial Hospital from January 2015 to July 2022 were collected.According to the surgical method,the patients were divided into LPD group and OPD group.A 1:1 propensity score matching(PSM)and Kaplan-Meier method were used to compare the perioperative and long-term outcomes of LPD and OPD.Results:A total of 273 patients were included in the study(LPD:157,OPD:116).There was a difference in age between the two groups before PSM(65 vs.62.5,P=0.005),and no statistically significant difference in baseline data between the two groups in the 106 group after PSM.The length of hospital stay after PSM was shorter than that of OPD(12.5 vs.16.5 days,P<0.001),the length of operation was longer than that of OPD(375 vs.330,P<0.001),and there was postoperative bleeding(5.66%vs.6.60%,P=0.775),pancreatic leakage(B+C)(10.38%vs.7.55%,P=0.471),bile leakage(9.43%vs.6.60%,P=0.448),delayed gastric emptying(B+C)(11.32%vs.6.60%,P=0.229),gastrointestinal anastomotic leakage(4.72%vs.1.89%,P=0.249),abdominal infection(21.70%vs.19.81%,P=0.735),and secondary operation(4.72%vs.4.72%,P=1.000)had no statistically significant difference in incidence compared with OPD group.The incidence of postoperative serious complications(14.15%vs.11.32%,P=0.537)and mortality within 90 days after surgery(1.89%vs.2.83%,P=0.651)were not significantly different in the LPD group compared with the OPD group.There was no significant difference in 1-year,2-year,and 3-year survival after the PSM between the LPD group and the OPD group(83.02%vs.84.96%,P=0.708;64.15%vs.61.32%,P=0.670;38.67%vs.37.74%,P=0.888).Conclusion:For DCC patients,the incidence of postoperative complications of LPD and OPD was similar.The operation time of LPD was longer,but the length of postoperative hospital stay was shorter.There was no significant difference in the 1-year,2-year and 3-year postoperative survival rates between the two groups.LPD is safe and feasible to treat DCC patients.