Ann Hepatobiliary Pancreat Surg.  2021 Aug;25(3):358-365. 10.14701/ahbps.2021.25.3.358.

Comparison of perioperative outcomes in pancreatic head cancer patients following either a laparoscopic or open pancreaticoduodenectomy with a superior mesenteric artery first approach

• Park MY
• Lee W
• Kwon J
• Song KB
• Hwang DW
• Lee JH
• Kim SC

• KMID: 2519292
• DOI: http://doi.org/10.14701/ahbps.2021.25.3.358

Abstract

Backgrounds/Aims
A superior mesenteric artery first approach (SFA) technique can improve the complete resection rate. It can be used to determine whether an operation can be performed by invading the superior mesenteric artery before performing a pancreatic transection in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to compare perioperative outcomes between laparoscopic and open SFA for PDAC.
Methods
Between January 2017 and August 2019, consecutive patients who underwent laparoscopic and open pancreaticoduodenectomy (PD) for PDAC using SFA procedures were included and compared between laparoscopic and open procedures.
Results
Fourteen and 83 patients underwent laparoscopic and open surgeries, respectively. In perioperative outcomes, there were no significant differences in the amount of intraoperative blood loss or transfusion rate between the two groups. In the laparoscopic group, the operation time was longer with less patients showing wound infection. R0 resection rate and the number of retrieved lymph nodes showed no significant difference. The average time to adjuvant chemotherapy was longer in the open group. There was no significant difference in the mean survival time or the recurrence free period.
Conclusions
Patients who underwent laparoscopic PD using SFA showed perioperative outcomes comparable compared to those of patients who underwent open procedures performed by experienced surgeons.

Keyword

Carcinoma; pancreatic ductal; Pancreaticoduodenectomy; Mesenteric artery; superior; Laparoscopes

Figure

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  Fig. 1 The range of soft tissue dissection around the pancreas with the SMA first approach technique. Surgical extents included all soft tissues and nerve bundles located 180° to the right side of the SMA. SMV, superior mesenteric vein; SMA, superior mesenteric artery; IPDA, inferior pancreaticoduodenal artery.

• 

  Fig. 2 Kaplan-Meier estimates of overall survival (A) and recurrence free survival (B) for the open SFA group and the laparoscopic SFA group. (A) The mean survival time was 30.8 months (95% CI, 25.1–36.5 months) for the laparoscopic group and 30.5 months (95% CI, 27.8–33.2 months) for the open group (p = 0.997). (B) The mean time to recurrence was 18.8 months (95% CI, 13.4–24.1 months) for the laparoscopic group and 23.2 months (95% CI, 19.9–26.6 months) for the open group (p = 0.621). SFA, superior mesenteric artery first approach; CI, confidence interval.

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