Comparison On The Short-term Efficacy Of Laparoscopic And Open Pancreaticoduodenectomy In Elderly Patients

Objective:By collecting clinical data of senile patients who received open pancreaticoduodenectomy(OPD)and laparoscopic pancreaticoduodenectomy(LPD),and comparing the short-term efficacy of OPD and LPD,this paper discussed whether LPD is safe and effective in the treatment of senile patients,and provided some clinical experience for laparoscopic treatment of senile patients with pancreatic and periampullary tumors.Methods:Our research retrospectively collected and analyzed the clinical data of 96 patients over60 years who received OPD or LPD at Department of Hepatopancreatobiliary Surgery,affiliated Hospital of Qingdao University from January 2016 to December 2019.There were 74 cases in OPD group and 22 cases in LPD group.Demographic,clinical and pathological data were extracted from the corresponding clinical medical records.Baseline features included age,sex,body mass index(BMI),Age-adjusted Charlson Complication Index(a CCI),American Society of Anesthesiologists Score(ASA),tumor differentiation,tumor location,maximum tumor diameter,Carbohydrate antigen 199,(CA19-9)and pancreatic duct diameter.The propensity score matching method was used to match the patients of the two groups at 1:1.The data were analyzed and processed by SPSS23.0statistical software,and the short-term effects of the two groups were compared.Results:After matching the tendency score,there were 20 patients in OPD group and 20 patients in LPD group.There were 16 males and 4 females in OPD group,the age was(66.6 ±4.5)years old.There were 12 males and 8 females in LPD group,the age was(66.2 ±5.1)years old.No significant difference was noted in baseline data such as age,sex,BMI,ASA grade,a CCI and preoperative CA19-9 between the two groups(P > 0.05).Operation time after propensity score matching: LPD group(501.3 ±75.6)min vs.OPD group(321.5 ±66.8)min,P < 0.001.Number of lymph nodes removed: LPD group 14(6)vs.OPD group 10(5)min,P =0.003.Hospitalization costs: LPD group 9.9(5.6)vs.OPD group 8.3(3.3),P =0.048.The first exhaust time after operation: LPD group 3.5(1)d vs.OPD group 5(3)d,P =0.022.Postoperative biochemical leakage: LPD group 15% vs.OPD group 45%,P =0.038.No significant difference was noted in intraoperative blood loss,R0 resection rate,postoperative hospital stay time,postoperative first feeding time and short-term postoperative complications between the two groups(P > 0.05).After matching,the 1-year cumulative overall survival rates of the two groups were 83.5% in OPD group and 79.2%in LPD group,respectively,and the difference was not statistically significant(P=0.450).Conclusion:1.Although the operation time is long,LPD can be safely used in the treatment of senile patients with pancreatic and periampullary tumors.It does not increase the overall incidence of postoperative complications,and even is superior to OPD in some perioperative indexes.2.LPD has the same radical effect and short-term prognosis as OPD,and it can be carried out in experienced medical centers.