Risk Factors Of Nerve And Vascular Infiltration In Pancreatic Head Carcinoma And Their Relationship With Complications And Clinical Prognosis After Laparoscopic Pancreaticoduodenectomy

Objective:In this study,the perioperative clinical data of 129 patients with pancreatic head cancer were retrospectively analyzed,and the long-term tumor results were statistically analyzed with long-term follow-up.To analyze the risk factors of nerve and vascular infiltration of pancreatic head carcinoma and their relationship with complications after laparoscopic pancreaticoduodenectomy,and the clinical indicators related to the survival prognosis of pancreatic head carcinoma after radical surgery are helpful for the selection of surgical methods and scientific decision-making of other diagnostic and treatment measures for pancreatic cancer,which is of great significance in improving the prognosis and survival rate of patients,and can provide theoretical basis for clinical intervention in a better and more timely manner.Methods:The perioperative clinical data and postoperative follow-up data of 129 patients with pancreatic head cancer who received laparoscopic pancreaticoduodenectomy in the Second Department of Hepatobiliary Surgery,First Hospital of Jilin University from April 2016 to May 2020 were retrospectively analyzed.Some clinical factors were selected and analyzed by statistical software.Results:Among 129 patients with pancreatic head cancer who received laparoscopic pancreaticoduodenectomy,71 were males(55.04%)and 58 were females(45.96%),with an average age of 58.46±8.90 years and a mean BMI of 23.00±2.71 Kg/m~2.The mean value of preoperative CA199 was 273.10±248.44U/L,the mean value of preoperative CA125 was 21.46±23.53U/L,and the mean value of preoperative total bilirubin level was 143.47±119.30μmol/L.There were 49 patients(37.98%)with preoperative puncture to reduce yellow,including 46 patients with PTGBD and 3patients with PTCD.Among the basic diseases,there were 32(24.81%)patients complicated with cardiovascular disease,68(52.71%)patients complicated with preoperative fasting glucose elevation(>6.1mmol/L),5(3.88%)patients complicated with chronic pancreatitis,3(2.33%)patients complicated with chronic hepatitis,and19(14.73%)patients with previous abdominal surgery.Postoperative complications in patients with a total of 39 cases(30.23%),11(8.53%)cases of postoperative bleeding,20(15.50%)cases of postoperative pancreatic fistula,10(4.37%)cases of biliary fistula after surgery,3(2.33%)cases of postoperative gastric paralysis,21(16.28%)cases of postoperative abdominal infection,2(1.55%)cases of postoperative ileus,2(1.55%)cases of postoperative gastrointestinal fistula,3(2.33%)case of postoperative pulmonary infection,13(10.08%)cases of postoperative non-chemotherapy readmission.There were 112(86.82%)cases of pancreatic cancer with nerve infiltration,82(63.57%)cases with vascular infiltration,and 79(61.24%)cases with lymph node invasion.The mean positive rate of lymph node was 10(0,25.5)%.There were 13(10.08%)patients with the largest tumor diameter≤2cm,100(77.52%)patients with 2-4cm,and 16(12.40%)patients with>4cm.The degree of tumor differentiation:71 cases(55.04%)were poorly differentiated or moderate-poorly differentiated,while 58 cases(44.96%)were moderately differentiated,moderate-well differentiated or highly differentiated.TNM stages:stage IA 7 cases,the IB 37 cases,ⅡA stage 4 cases,ⅡB phase of 61 cases,Ⅲperiod(19 cases),Ⅳperiod in 1 case.A total of 40 cases(31.01%)received postoperative chemotherapy.All 129 patients were followed up effectively,with a median survival of 649 days.Conclusions:1.Univariate analysis showed that nerve infiltration in pancreatic cancer was a risk factor for postoperative pancreatic fistula and postoperative abdominal infection.2.Univariate analysis showed that preoperative elevated blood glucose,TNM stage,degree of differentiation,vascular invasion,lymph node invasion and positive lymph node rate were risk factors for nerve invasion of pancreatic cancer.Preoperative hyperglycemia,TNM stage,nerve infiltration,lymph node invasion and positive lymph node rate are the risk factors for pancreatic cancer vessel invasion.Multivariate analysis showed that elevated fasting blood glucose level and vascular infiltration were the risk factors for nerve infiltration of pancreatic cancer,while nerve infiltration and lymph node invasion were the risk factors for vascular infiltration of pancreatic cancer.3.Univariate analysis showed that preoperative fasting glucose elevation was a risk factor for nerve infiltration,vascular infiltration,lymph node invasion and positive lymph node rate of pancreatic cancer.4.Univariate analysis showed that nerve invasion,vascular invasion,lymph node invasion,positive lymph node ratio,preoperative fasting blood glucose increase,tumor maximum diameter,tumor stage,tumor differentiation degree,and postoperative radiotherapy were risk factors affecting the median postoperative survival of pancreatic cancer patients.Multivariate analysis showed that nerve infiltration,positive lymph node rate,maximum tumor diameter,tumor stage,and postoperative chemotherapy were the risk factors affecting the median postoperative survival of pancreatic cancer patients.