| Objective To investigate the advantages and clinical value of artery-first approach for laparoscopic pancreaticoduodenectomy.Methods Clinical data of 61 patients underwent AF-LPD by a single surgeon during2015 January 1st to 2020 December 31 st at Affiliated Anhui Provincial Hospital of Anhui Medical University was analysed retrospectively and compared with the same period pancreaticoduodenectomy.The learning curve of laparoscopic pancreaticoduodenectomy was ploted by CUSUM and the break point was defined by Borken-line model.The perioperative treatment outcomes of AF-LPD at different learning stages were analyzed.Patients who underwent AF-LPD and OPD were followed up to compare the difference in survival.Results A total of 210 patients were included in this study,including 149 patients underwent OPD and 61 patients underwent AF-LPD.The median operative time of 61 patients receiving AF-LPD was 610(540-668)min,the median intraoperative blood loss was 500(300-600)ml,and postoperative complications occurred in 35 patients(57.4%).33 cases(54.1%)patients with postoperative pancreatic fistula,including biochemical fistula in 15 cases(24.6%),grade B fistula in 17(27.9%),grade C fistula in 1 case(1.6%),28 patients(45.9%)occurred postoperative gastric emptying.3 patients(4.9%)had postoperative bleeding and underwent reoperation.There were no perioperative deaths.According to CUSUM,61 cases of AF-LPD was divided into three phases,the phase I including 1 cases to 10 cases,the phase II including 11 to 20 cases,the phase III including 20 cases to 61 cases.the clinical data of the three subgroup was analysed.With the increase of surgery cases,operative time and intraoperative bleeding significantly reduced.postoperative complications,reoperation rate,mortality rate,average observation indexes were no significant differences.Compared with the OPD group,the AF-LPD group had a longer operative time(410(345-480)min vs.610(540-668)min,P < 0.001),while the AF-LPD group had significantly less blood loss after passing the learning curve than the open group(500(400-600)ml vs.400(300-600)ml,P=0.011).In terms of long-term prognosis,the median follow-up time was37 months in the OPD group and 32 months in the AF-LPD group.There was no significant difference in overall survival between the two groups.(P = 0.768).Conclusion AF-LPD is a feasible and technically safe procedure.AF-LPD could achieve equivalent short and long-term outcomes compared with OPD.However,due to the long learning curve,complicated intraoperative conditions and high rate of postoperative complications,we suggested AF-LPD should be performed routinely in large pancreatic centers. |
