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Purpose: The purpose of this study is to evaluate the efficacy of laparoscopic pancreaticoduodenectomy (LPD) with superior mesenteric artery (SMA) left posterior first approach and circumferential lymphadenectomy with total meso-pancreas (MP) dissection for periampullary malignancies. Methods: 31 patients who underwent LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection between September 2021 and September 2023. General characteristics, operative techniques, short-term outcomes and pathological results were prospectively evaluated. Results: The mean operation time and SMA first-approach time were 441.9 ± 73.7 min and 99.9 ± 27.7 min, respectively. The median intraoperative blood loss was 143 ml (range: 50–1500 ml). The median number of total LNs and left-sided SMA LNs harvested were 32,7 ± 13 (16—74) and 7,4 ± 6 (range: 3—30), respectively. The rate of metastatic left-sided SMA LNs and meso-pancreas were 25.8% and 22.6%, respectively. 22.6% of patients had pancreatic fistula, but mostly in grade A, with only one case that required conversion. Only one case developed postoperative refractory diarrhea. The mean postoperative hospital stay was 14.1 days. No 90-day mortality was reported. Conclusion: LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection was safe and effective with favorable short-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Pancreaticojejunostomy have been studied and modified for more than a hundred years. We investigated a new method of pancreaticojejunostomy to explore its value in laparoscopic pancreaticoduodenectomy. Patients and Methods: A retrospective analysis was conducted on the clinical data of 93 patients who underwent laparoscopic pancreaticoduodenectomy with 'Shunt-block combined' pancreaticojejunostomy at Ningbo Medical Center Lihuili Hospital from April 2017 to February 2023. Results: All patients successfully completed the surgery, with two cases requiring conversion to open surgery. The average operation time was 328.5 (180–532) min, the average intraoperative blood loss was 182.9 (50–1000) mL and the average laparoscopic pancreaticojejunostomy time was 29.6 (20–39) min. There were no cases of grade C pancreatic fistula postoperatively, 10 cases of grade B pancreatic fistula, 43 cases of biochemical fistula and 40 cases without detected pancreatic fistula. Conclusion: 'Shunt-block combined' pancreaticojejunostomy was a safe and effective method for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]

Objective: The value of robotic pancreaticoduodenectomy (RPD) compared with laparoscopic pancreaticoduodenectomy (LPD) for pancreatic and periampullary tumors is controversial. This study aims to assess the available literature and compare the short outcomes of RPD and LPD. Methods: The PubMed, Cochrane Library, Embase, and Web of Science databases were searched to identify available research published up to 24 July, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Seventeen studies with a total of 9417 patients (RPD group: 3334 patients; LPD group: 6083 patients) were included in this meta-analysis. The RPD group had lower overall morbidity (RR, 0.79), conversion (RR, 0.29) and blood transfusion rates (RR, 0.61), shorter length of stay (MD, -0.72 days), and higher number of harvested lymph nodes (MD, 0.62) than the LPD group. There were no significant differences in 90-day mortality (RR, 0.89), major complications (RR, 0.87), operative time (MD, -3.74 mins), blood loss (MD, -24.14 mL), reoperation (RR, 0.94), bile leak (RR, 0.62), postoperative pancreatic hemorrhage (RR, 0.96), postoperative pancreatic fistula (RR, 0.74), delayed gastric emptying (RR, 1.24), and R0 resection (RR, 1.00) between the groups. Conclusions: Compared with LPD, RPD for pancreatic and periampullary tumors could be safe and effective, and it has superior surgical outcomes. Further randomized controlled trials to verify the potential advantages of RPD over LPD are necessary. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display%5frecord.php?RecordID=581133 , identifier CRD42024581133. [ABSTRACT FROM AUTHOR]

Laparoscopic pancreaticoduodenectomy (LPD) with superior mesenteric/portal vein (SMV/PV) resection and reconstruction was the most technically challenging procedure and had been rarely reported. However, single-incision plus one-port LPD (SILPD +1) with SMV/PV resection and reconstruction has never been reported. In this study, we will demonstrate the feasibility, safety, key surgical procedure, and long-term outcomes for SILPD +1 with SMV/PV resection and reconstruction using video evidence. Two cases of SILPD +1 with SMV/PV wedge resection were carried out by the authors. There was no tumor recurrence during the one-year follow-up. It is worth noting that skilled laparoscopic technicians are necessary to safely complete the procedure with good short-term and long-term outcomes.

Abstract Background The feasibility and safety of laparoscopic pancreaticoduodenectomy (LPD) in overweight patients is still controversial. This study was designed to analyze the impact of overweight on surgical outcomes in patients undergoing LPD. Methods Data from patients who underwent LPD between January 2018 and July 2022 were analyzed retrospectively. A 1:1 propensity score-matching (PSM) analysis was performed to minimize bias between groups. Results A total of 432 patients were enrolled, with a normal weight group (n = 241) and an overweight group (n = 191). After matching, 144 patients were enrolled in each group. The results showed that the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and delayed gastric emptying (DGE) was significantly higher in the overweight group compared to the normal weight group (P = 0.036). However, there were no significant differences in perioperative mortality (1.4% vs. 2.1%, P = 0.652) and long-term survival outcomes between malignancy patients with different body mass index (BMI) before and after PSM (all P > 0.05). Conclusions It is safe and feasible for overweight patients to undergo LPD with mortality and long-term survival outcomes comparable to the normal weight group. High-quality prospective randomized controlled trials are still needed.

Background: The feasibility and safety of laparoscopic pancreaticoduodenectomy (LPD) in overweight patients is still controversial. This study was designed to analyze the impact of overweight on surgical outcomes in patients undergoing LPD. Methods: Data from patients who underwent LPD between January 2018 and July 2022 were analyzed retrospectively. A 1:1 propensity score-matching (PSM) analysis was performed to minimize bias between groups. Results: A total of 432 patients were enrolled, with a normal weight group (n = 241) and an overweight group (n = 191). After matching, 144 patients were enrolled in each group. The results showed that the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and delayed gastric emptying (DGE) was significantly higher in the overweight group compared to the normal weight group (P = 0.036). However, there were no significant differences in perioperative mortality (1.4% vs. 2.1%, P = 0.652) and long-term survival outcomes between malignancy patients with different body mass index (BMI) before and after PSM (all P > 0.05). Conclusions: It is safe and feasible for overweight patients to undergo LPD with mortality and long-term survival outcomes comparable to the normal weight group. High-quality prospective randomized controlled trials are still needed. [ABSTRACT FROM AUTHOR]

Although recent advances in laparoscopic technology have popularized laparoscopic pancreatoduodenectomy (LPD), laparoscopic pancreaticojejunostomy anastomosis (PJA) still presents a major technical challenge. From February 2021 to January 2023, 42 patients underwent LPD with modified double U-suture PJA. Data on the demographic characteristics and clinical results of these patients were investigated. The median operation time was 316 min (249–596 min). The median PJA time was 32 min (25–40 min). The median intraoperative blood loss was 150 mL (50–500 mL). The median postoperative stay was 12 days (7–30 days). Complications occurred in 10 (23.8%) patients, including two cases (4.8%) of delayed gastric emptying and nine cases (21.4%) of postoperative pancreatic fistula (POPF). One patient presented delayed gastric emptying and POPF. Eight patients (19.0%) experienced biochemical leakage, and one patient (2.4%) had grade B POPF. Laparoscopic double U-suture PJA is a feasible and safe technique for performing LPD. [ABSTRACT FROM AUTHOR]

Background: Evidence is limited for the treatment of pancreatic cancer among minimally invasive pancreatoduodenectomy. Methods: This retrospective analysis evaluated patients who underwent robotic pancreaticoduodenectomy (RPD) or laparoscopic pancreaticoduodenectomy (LPD) from April 2016 to April 2023. Their baseline and perioperative data, including operative time, R0 resection rates, and severe complications rates, were analyzed, and the follow-up data, such as disease-free survival (DFS) and overall survival (OS), were collected. Results: A total of 253 cases of LPD and RPD were performed, and 101 cases with pancreatic cancer were included, of which 54 were LPD and 47 were RPD. The conversion rate (4.3% vs. 29.6%, p = 0.001) and blood loss (400 vs. 575 mL, p < 0.05) were lower in the RPD group. No significant difference was observed between the two groups in terms of operative time, vessel resection rates, and TNM-stage diagnosis; however, R0 resection rates (80.9% vs. 70.4%) and lymph node harvest (24.2 vs. 21.9) had a higher tendency in the RPD group, and postoperative length of stay was shorter in the RPD cohort (11 vs. 13 days). Moreover, improved 1- to 3-years DFS (75.7%, 61.7%, and 36.0% vs. 59.0%, 35.6%, and 21.9%) and OS (94.7%, 84.7%, and 50.8% vs. 84.1%, 63.6%, and 45.5%) was found in the RPD group in comparison with the LPD group. Conclusions: RPD had advantages in surgical safety and oncological outcomes compared with LPD, but was similar to the latter in perioperative outcomes. Long-term outcomes require further study. [ABSTRACT FROM AUTHOR]

Objective: To delineate the risk factors and causes of unplanned reoperations within 30 days following laparoscopic pancreaticoduodenectomy (LPD). Methods: A retrospective study reviewed 311 LPD patients at Ningbo Medical Center Li Huili Hospital from 2017 to 2024. Demographic and clinical parameters were analyzed using univariate and multivariate analyses, with P < 0.05 indicating statistical significance. Results: Out of 311 patients, 23 (7.4%) required unplanned reoperations within 30 days post-LPD, primarily due to postoperative bleeding (82.6%). Other causes included anastomotic leakage, abdominal infection, and afferent loop obstruction. The reoperation intervals varied, with the majority occurring within 0 to 14 days post-surgery. Univariate analysis identified significant risk factors: diabetes, liver cirrhosis, elevated CRP on POD-3 and POD-7, preoperative serum prealbumin < 0.15 g/L, prolonged operation time, intraoperative bleeding > 120 ml, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter =3 mm (all P < 0.05). Multivariate analysis confirmed independent risk factors: pre-operative serum prealbumin < 0.15 g/L (OR = 3.519, 95% CI 1.167-10.613), CRP on POD-7 (OR = 1.013, 95% CI 1.001-1.026), vascular reconstruction (OR = 9.897, 95% CI 2.405-40.733), soft pancreatic texture (OR = 5.243, 95% CI 1.628-16.885), and a main pancreatic duct diameter =3 mm (OR = 3.462, 95% CI 1.049-11.423), all associated with unplanned reoperation within 30 days post-LPD (all P < 0.05). Conclusion: Postoperative bleeding is the primary cause of unplanned reoperations after LPD. Independent risk factors, confirmed by multivariate analysis, include low pre-operative serum prealbumin, elevated CRP on POD-7, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter of =3 mm. Comprehensive peri-operative management focusing on these risk factors can reduce the likelihood of unplanned reoperations and improve patient outcomes. [ABSTRACT FROM AUTHOR]

In October 2023, the first laparoscopic pancreaticoduodenectomy (LPD) operation was successfully conducted in Bangladesh. This case study reported the surgical technique and outcomes of Bangladesh's first LPD procedure. The patient was a 55-year-old male patient with the diagnosis of periampullary carcinoma. He underwent a classical LPD lasting 360 ​min with a blood loss of 170 ​ml. Postoperatively, he experienced no major complications such as pancreatic fistula or bile leakage but developed atelectasis, which was managed effectively. His postoperative pain, assessed on a scale from 0 to 5, significantly reduced from day 3 (score 3) to day 7 (score 1). Histological examination confirmed adenocarcinoma at the ampullary site, with an R0 resection margin achieved. Sixteen lymph nodes were retrieved, none of which showed involvement. His hospital stay was 10 days, and he returned to work 14 days post-discharge. This operation marks a significant milestone in advancing surgical practices in Bangladesh. The successful completion of the first LPD in Bangladesh demonstrated the procedure's feasibility, safety, and potential benefits in a similar resource-limited setting.

Laparoscopic pancreaticoduodenectomy (LPD) with superior mesenteric/portal vein (SMV/PV) resection and reconstruction was the most technically challenging procedure and had been rarely reported. However, single-incision plus one-port LPD (SILPD +1) with SMV/PV resection and reconstruction has never been reported. In this study, we will demonstrate the feasibility, safety, key surgical procedure, and long-term outcomes for SILPD +1 with SMV/PV resection and reconstruction using video evidence. Two cases of SILPD +1 with SMV/PV wedge resection were carried out by the authors. There was no tumor recurrence during the one-year follow-up. It is worth noting that skilled laparoscopic technicians are necessary to safely complete the procedure with good short-term and long-term outcomes. [ABSTRACT FROM AUTHOR]

Abstract Objective Achieving textbook outcome (TO) implies a smooth recovery post-operation without specified composite complications. This study aimed to evaluate TO in laparoscopic pancreaticoduodenectomy (LPD) and identify independent risk factors associated with achieving TO. Methods We conducted a retrospective analysis of data from a randomized controlled trial on LPD at West China Hospital (ChiCTR1900026653). Patients were categorized into the TO and non-TO groups. Perioperative variables were compared between these groups. Multivariate logistic regression was utilized to identify the risk factors. Results A total of 200 consecutive patients undergoing LPD were included in this study. TO was achieved in 82.5% (n = 165) of the patients. Female patients (OR: 2.877, 95% CI: 1.219–6.790; P = 0.016) and those with a hard pancreatic texture (OR: 2.435, 95% CI: 1.018–5.827; P = 0.046) were associated with an increased likelihood of achieving TO. Conclusions TO can be achieved in more than 80% of patients in a high-volume LPD center. Independent risk factors associated with achieving TO included gender (male) and pancreatic texture (soft).

Introduction: Laparoscopic Whipple’s pancreaticoduodenectomy (WPD) is one of the most advanced minimally invasive procedures. In recent years, with advancements in minimally invasive surgery, laparoscopic WPD has been increasingly adopted as a safe and feasible technique. This study aims to compare the short-term and long-term outcomes of laparoscopic WPD to open WPD in resectable ampullary, periampullary and head of pancreas malignancies. Patients and Methods: A retrospective analysis of a prospectively maintained database of patients who underwent WPD from January 2015 to January 2021 at the department of surgical gastroenterology in a tertiary care medical college hospital was conducted. Patient demographics and pre-operative details, intraoperative parameters (operating time and blood loss), post-operative length of hospital stay, median intensive care unit (ICU) stay, time to resume oral diet, post-operative complications, interventional procedures, mortality, 3-year survival, 3 year recurrence-free survival and overall survival were analysed. Results: Forty-two patients underwent WPD during our study period; 14 patients underwent laparoscopic WPD and 28 patients underwent open WPD. None required conversion. The majority of the patients had periampullary carcinoma in both the groups. Laparoscopic WPD showed a trend towards shorter ICU stays, hospital stays and surgical site infections (SSIs) compared to open WPD. The median operating time was significantly longer in the laparoscopic WPD group (380 min) compared to the open group (285 min). However, median blood loss was significantly lower in the laparoscopic group (250 mL vs. 300 mL). The pancreas-specific post-operative complications like delayed gastric emptying, post-operative pancreatic fistula or post-operative pancreatic haemorrhage did not differ significantly between the groups. All patients had R0 resection and the mean lymph node yield was comparable between the two groups (14.92 vs. 13.42). The reoperation rate or mortality rate did not show any statistical significance between the two groups. The overall survival was 46 months in the open group and 48 months in the laparoscopic group. Three-year survival was 74.1% in the open WPD group and 69.2% in the laparoscopic group. Three-year recurrence-free survival was 55.5% in the open group and 69.23% in the laparoscopic group. Conclusion: Laparoscopic WPD appears to be safe and feasible, with similar short-term and long-term survival outcomes. With a trend favouring laparoscopic WPD in terms of blood loss, hospital and ICU stay and post-operative SSIs, it should be offered to selected patients when the expertise is available.

Objective: Achieving textbook outcome (TO) implies a smooth recovery post-operation without specified composite complications. This study aimed to evaluate TO in laparoscopic pancreaticoduodenectomy (LPD) and identify independent risk factors associated with achieving TO. Methods: We conducted a retrospective analysis of data from a randomized controlled trial on LPD at West China Hospital (ChiCTR1900026653). Patients were categorized into the TO and non-TO groups. Perioperative variables were compared between these groups. Multivariate logistic regression was utilized to identify the risk factors. Results: A total of 200 consecutive patients undergoing LPD were included in this study. TO was achieved in 82.5% (n = 165) of the patients. Female patients (OR: 2.877, 95% CI: 1.219–6.790; P = 0.016) and those with a hard pancreatic texture (OR: 2.435, 95% CI: 1.018–5.827; P = 0.046) were associated with an increased likelihood of achieving TO. Conclusions: TO can be achieved in more than 80% of patients in a high-volume LPD center. Independent risk factors associated with achieving TO included gender (male) and pancreatic texture (soft). [ABSTRACT FROM AUTHOR]

Background: The advancement of laparoscopic technology has broadened the application of laparoscopic pancreaticoduodenectomy (LPD) for treating pancreatic head and ampullary tumors. Despite its benefits, postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH) remain significant complications. Ligamentum teres hepatis wrapping around the gastroduodenal artery (GDA) stump show limitations in reducing POPF and PPH. Methods: This study retrospectively analyzed patients undergoing LPD from January 2016 to October 2023, We compared the effectiveness of the two-parts wrapping (the ligamentum teres hepatis wrapping of the gastroduodenal artery stump and the omentum flap wrapping of the pancreatojejunal anastomosis) and ligamentum teres hepatis wrapping around the gastroduodenal artery (GDA) in reducing postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH), using propensity score matching for the analysis. Results: A total of 172 patients were analyzed, showing that the two-parts wrapping group significantly reduced the rates of overall and severe complications, POPF, and PPH compared to ligamentum teres hepatis wrapping around the GDA group. Specifically, the study found lower rates of grade B/C POPF and no instances of PPH in the two-parts wrapping group, alongside shorter postoperative hospital stays and drainage removal times. These benefits were particularly notable in patients with soft pancreatic textures and pancreatic duct diameters of < 3 mm. Conclusion: The two-parts wrapping technique significantly reduce the risks of POPF and PPH in LPD, offering a promising approach for patients with soft pancreas and pancreatic duct diameter of < 3 mm. [ABSTRACT FROM AUTHOR]

Background: Celiac axis stenosis can potentially lead to insufficient blood supply to vital organs, such as the liver, spleen, pancreas, and stomach. This condition result in the development of collateral circulation between the superior mesenteric artery and the hepatic artery. However, these collateral circulations are often disrupted during pancreaticoduodenectomy (PD), which may increase the risk of postoperative complications. Methods: A retrospective analysis was conducted on patients who underwent laparoscopic pancreaticoduodenectomy (LPD) from April 2015 to April 2023. Celiac trunk stenosis is classified according to the degree of stenosis: no stenosis (<30%), grade A (30%–<50%), grade B (50%–≤80%), and grade C (>80%). The incidence of postoperative complications was evaluated, and both univariate and multivariate risk analyses were conducted. Results: A total of 997 patients were included in the study, with mild celiac axis stenosis present in 23 (2.3%) patients, moderate stenosis in 18 (1.8%) patients, and severe stenosis in 10 (1.0%) patients. Independent risk factors for the development of bile leakage, as identified by both univariate and multivariate analyses, included body mass index (BMI) (HR = 1.108, 95% CI = 1.008–1.218, P =.033), intra-abdominal infection (HR = 2.607, 95% CI = 1.308–5.196, P =.006), postoperative hemorrhage (HR = 4.510, 95% CI = 2.048–9.930, P = <0.001), and celiac axis stenosis (50%–≤80%, HR = 4.235, 95% CI = 1.153–15.558, P =.030), and (>80%, HR = 4.728, 95% CI =.882–25.341, P =.047). Celiac axis stenosis, however, was not determined to be an independent risk factor for pancreatic fistula (P > 0.05). Additionally, the presence of an aberrant hepatic artery did not significantly increase the risk of postoperative complications when compared with celiac axis stenosis alone. Conclusion: Severe celiac axis stenosis is an independent risk factor for postoperative bile leakage following LPD. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic Whipple’s pancreaticoduodenectomy (WPD) is one of the most advanced minimally invasive procedures. In recent years, with advancements in minimally invasive surgery, laparoscopic WPD has been increasingly adopted as a safe and feasible technique. This study aims to compare the short-term and long-term outcomes of laparoscopic WPD to open WPD in resectable ampullary, periampullary and head of pancreas malignancies. Patients and Methods: A retrospective analysis of a prospectively maintained database of patients who underwent WPD from January 2015 to January 2021 at the department of surgical gastroenterology in a tertiary care medical college hospital was conducted. Patient demographics and pre-operative details, intraoperative parameters (operating time and blood loss), post-operative length of hospital stay, median intensive care unit (ICU) stay, time to resume oral diet, post-operative complications, interventional procedures, mortality, 3-year survival, 3 year recurrence-free survival and overall survival were analysed. Results: Forty-two patients underwent WPD during our study period; 14 patients underwent laparoscopic WPD and 28 patients underwent open WPD. None required conversion. The majority of the patients had periampullary carcinoma in both the groups. Laparoscopic WPD showed a trend towards shorter ICU stays, hospital stays and surgical site infections (SSIs) compared to open WPD. The median operating time was significantly longer in the laparoscopic WPD group (380 min) compared to the open group (285 min). However, median blood loss was significantly lower in the laparoscopic group (250 mL vs. 300 mL). The pancreas-specific post-operative complications like delayed gastric emptying, post-operative pancreatic fistula or post-operative pancreatic haemorrhage did not differ significantly between the groups. All patients had R0 resection and the mean lymph node yield was comparable between the two groups (14.92 vs. 13.42). The reoperation rate or mortality rate did not show any statistical significance between the two groups. The overall survival was 46 months in the open group and 48 months in the laparoscopic group. Three‑year survival was 74.1% in the open WPD group and 69.2% in the laparoscopic group. Three‑year recurrence‑free survival was 55.5% in the open group and 69.23% in the laparoscopic group. Conclusion: Laparoscopic WPD appears to be safe and feasible, with similar short-term and long-term survival outcomes. With a trend favouring laparoscopic WPD in terms of blood loss, hospital and ICU stay and post-operative SSIs, it should be offered to selected patients when the expertise is available. [ABSTRACT FROM AUTHOR]

Background: Historically, pancreaticoduodenectomy (PD) has been performed via a laparotomy, but increasingly, laparoscopic and robotic platforms are being employed for PD. Laparoscopic PD has a steep surgeon specific learning curve and programmatic elements that must be optimized. These factors may limit a surgeon who is proficient at laparoscopic PD to develop a program at another institution. We hypothesize that the learning curve for a surgeon transferring a program to a second institution is shorter than the initial laparoscopic PD learning curve for the same surgeon. Methods: A retrospective review of patients who underwent laparoscopic PD for any indication at the first institution (FI) from 2012 to 2017 and the second institution (SI) from 2018 to 2021 was conducted. Standard statistical analysis was performed. The learning curve was identified using one-sided CUSUM analysis of operative times. Result: We identified 110 participants, 90 from the FI and 20 from the SI. More patients at the FI were diagnosed with periampullary adenocarcinoma on final pathology compared to the SI (65.6% vs 40.0%, P =.0132). FI operative times stabilized after the 25th laparoscopic PD and SI operative times stabilized after the 5th operation. No statistically significant difference was identified in postoperative complications. Conclusions: The learning curve and average operative time of an SI laparoscopic PD program was shorter than the initial learning curve for a single surgeon with comparable outcomes. This suggests that complex minimally invasive surgical programs can be safely transferred to another high-volume institution without significant loss of progress. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of metabolic syndrome (MetS) on short-term complications of laparoscopic pancreaticoduodenectomy (LPD). Materials and Methods: We retrospectively analyzed perioperative data of patients who underwent LPD in our department from January 2020 to January 2022. The patients were divided into the MetS group and non-MetS group based on whether they had MetS. The incidence of postoperative complications and mortality rate was compared between the two groups. Results: The study involved 279 patients, with 30 having MetS and 249 without. However, the MetS and non-MetS groups differed significantly in terms of postoperative pancreatic fistula rate (26.6% versus 8.4%), abdominal infection rate (33.3% versus 10.0%), pulmonary complications rate (16.7% versus 6.42%), Clavien–Dindo ≥3 rate (20% versus 8.0%), multiple complications rate (23.3% versus 9.6%), percutaneous drainage rate (33.3% versus 10.0%), 90-day mortality rate (6.7% versus 1.2%), and length of postoperative hospital stay (15.00 ± 12.78 versus 10.63 ± 5.23 days). However, the two groups differed no significantly with respect to age, gender, American Society of Anesthesiologists score, preoperative CA125/CA199 levels, surgery time, specimen removal time, and intraoperative blood loss. Conclusion: MetS increases the incidence of postoperative complications and perioperative mortality rate in LPD. [ABSTRACT FROM AUTHOR]

Background: Pancreaticoduodenectomy serves as the standard surgical treatment for periampullary tumors. Previous studies have suggested that high body mass index (BMI) is associated with an unfavorable prognosis following laparoscopic pancreaticoduodenectomy (LPD). However, the relationship between low BMI and postoperative complications remains unclear. Materials and Methods: A retrospective analysis of clinical data from 1130 patients who underwent LPD between April 2014 and December 2022 was conducted. Multivariate regression and restricted cubic spline analyses were utilized to explore the correlations between BMI and short-term outcomes, with adjustments for potential confounders. Results: Multivariable logistic regression revealed that overweight, obese, or severely underweight patients had an elevated risk of postoperative pancreatic fistula (POPF) compared to those with a normal BMI. Moreover, obesity was significantly correlated with a higher proportion of "failure to rescue." BMI exhibited a J-shaped relationship with respiratory complications and in-hospital mortality, a W-shaped relationship with multiple complications and anastomotic leakage (pancreatic fistula), and a U-shaped association with "failure to rescue" rates. The lowest risk was observed at BMI levels of 20 and 25 kg/m2 for multiple complications and pancreatic fistula, respectively. Conclusion: Both high and low BMI are identified as risk factors for the occurrence of postoperative POPF and in-hospital mortality following LPD. Notably, patients with higher BMI and severe underweight conditions are associated with an increased likelihood of "failure to rescue." [ABSTRACT FROM AUTHOR]

ObjectiveThe value of robotic pancreaticoduodenectomy (RPD) compared with laparoscopic pancreaticoduodenectomy (LPD) for pancreatic and periampullary tumors is controversial. This study aims to assess the available literature and compare the short outcomes of RPD and LPD.MethodsThe PubMed, Cochrane Library, Embase, and Web of Science databases were searched to identify available research published up to 24 July, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.ResultsSeventeen studies with a total of 9417 patients (RPD group: 3334 patients; LPD group: 6083 patients) were included in this meta-analysis. The RPD group had lower overall morbidity (RR, 0.79), conversion (RR, 0.29) and blood transfusion rates (RR, 0.61), shorter length of stay (MD, -0.72 days), and higher number of harvested lymph nodes (MD, 0.62) than the LPD group. There were no significant differences in 90-day mortality (RR, 0.89), major complications (RR, 0.87), operative time (MD, -3.74 mins), blood loss (MD, -24.14 mL), reoperation (RR, 0.94), bile leak (RR, 0.62), postoperative pancreatic hemorrhage (RR, 0.96), postoperative pancreatic fistula (RR, 0.74), delayed gastric emptying (RR, 1.24), and R0 resection (RR, 1.00) between the groups.ConclusionsCompared with LPD, RPD for pancreatic and periampullary tumors could be safe and effective, and it has superior surgical outcomes. Further randomized controlled trials to verify the potential advantages of RPD over LPD are necessary.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=581133, identifier CRD42024581133.

Abstract Background Delayed gastric emptying (DGE) commonly occurs after pancreaticoduodenectomy (PD). Risk factors for DGE have been reported in open PD but are rarely reported in laparoscopic PD (LPD). This study was designed to evaluate the perioperative risk factors for DGE and secondary DGE after LPD in a single center. Methods This retrospective cohort study included patients who underwent LPD between October 2014 and April 2023. Demographic data, preoperative, intraoperative, and postoperative data were collected. The risk factors for DGE and secondary DGE were analyzed. Results A total of 827 consecutive patients underwent LPD. One hundred and forty-two patients (17.2%) developed DGE of any type. Sixty-five patients (7.9%) had type A, 62 (7.5%) had type B, and the remaining 15 (1.8%) had type C DGE. Preoperative biliary drainage (p = 0.032), blood loss (p = 0.014), and 90-day any major complication with Dindo-Clavien score ≥ III (p

Abstract Background SMA-first approach in pancreatoduodenectomy (PD) has been widely applied in open surgery as well as laparoscopy. Finding the superior mesenteric artery (SMA), inferior pancreatoduodenal artery (IPDA), first jejunal artery (J1A) has become a great challenge in laparoscopic PD (LPD). Meanwhile, exposing the midde colic artery (MCA) might be a feasible approach to determine SMA, IPDA, and J1A. Our study aims to find the anatomical correlation between MCA and SMA, IPDA, J1A, especially in SMA-first approach LPD from the left. Methods Uncontrolled clinical trial with 33 patients undergoing LPD had preoperative contrast abdominal CT scan to analyze the anatomical relevance between MCA and SMA, J1A, IPDA. The operation was performed starting with exposing MCA in advance to find SMA, J1A and IPDA. The data was analyzed by SPSS 25.0. Results 90.9% of MCA started at 12–3 o’clock from SMA, the mean distance from the SMA root to the MCA and J1A was 56.4 mm and 37.4 mm, respectively. The distance between SMA and J1A was 19 mm. 72.7% J1A started at 9–12 o’clock, 69.7% J1A and IPDA had a common trunk. 78.8% IPDA started at 3–6 o’clock. 100% of the cases had J1A controlled intraoperatively, 81.8% for IPDA when approached from the left, 3% had MCA injury. The mean time to approach from the left was 98 min, median blood loss was 100 ml. Conclusion Exposing MCA first helps determine SMA, J1A and IPDA safely, efficiently and faciliates SMA-first approach LPD from the left and complete dissection of the mesopancreas and lymph nodes.

Background: SMA-first approach in pancreatoduodenectomy (PD) has been widely applied in open surgery as well as laparoscopy. Finding the superior mesenteric artery (SMA), inferior pancreatoduodenal artery (IPDA), first jejunal artery (J1A) has become a great challenge in laparoscopic PD (LPD). Meanwhile, exposing the midde colic artery (MCA) might be a feasible approach to determine SMA, IPDA, and J1A. Our study aims to find the anatomical correlation between MCA and SMA, IPDA, J1A, especially in SMA-first approach LPD from the left. Methods: Uncontrolled clinical trial with 33 patients undergoing LPD had preoperative contrast abdominal CT scan to analyze the anatomical relevance between MCA and SMA, J1A, IPDA. The operation was performed starting with exposing MCA in advance to find SMA, J1A and IPDA. The data was analyzed by SPSS 25.0. Results: 90.9% of MCA started at 12–3 o'clock from SMA, the mean distance from the SMA root to the MCA and J1A was 56.4 mm and 37.4 mm, respectively. The distance between SMA and J1A was 19 mm. 72.7% J1A started at 9–12 o'clock, 69.7% J1A and IPDA had a common trunk. 78.8% IPDA started at 3–6 o'clock. 100% of the cases had J1A controlled intraoperatively, 81.8% for IPDA when approached from the left, 3% had MCA injury. The mean time to approach from the left was 98 min, median blood loss was 100 ml. Conclusion: Exposing MCA first helps determine SMA, J1A and IPDA safely, efficiently and faciliates SMA-first approach LPD from the left and complete dissection of the mesopancreas and lymph nodes. [ABSTRACT FROM AUTHOR]

Background: Delayed gastric emptying (DGE) commonly occurs after pancreaticoduodenectomy (PD). Risk factors for DGE have been reported in open PD but are rarely reported in laparoscopic PD (LPD). This study was designed to evaluate the perioperative risk factors for DGE and secondary DGE after LPD in a single center. Methods: This retrospective cohort study included patients who underwent LPD between October 2014 and April 2023. Demographic data, preoperative, intraoperative, and postoperative data were collected. The risk factors for DGE and secondary DGE were analyzed. Results: A total of 827 consecutive patients underwent LPD. One hundred and forty-two patients (17.2%) developed DGE of any type. Sixty-five patients (7.9%) had type A, 62 (7.5%) had type B, and the remaining 15 (1.8%) had type C DGE. Preoperative biliary drainage (p = 0.032), blood loss (p = 0.014), and 90-day any major complication with Dindo-Clavien score ≥ III (p < 0.001) were independent significant risk factors for DGE. Seventy-six (53.5%) patients were diagnosed with primary DGE, whereas 66 (46.5%) patients had DGE secondary to concomitant complications. Higher body mass index, soft pancreatic texture, and perioperative transfusion were independent risk factors for secondary DGE. Hospital stay and drainage tube removal time were significantly longer in the DGE and secondary DGE groups. Conclusion: Identifying patients at an increased risk of DGE and secondary DGE can be used to intervene earlier, avoid potential risk factors, and make more informed clinical decisions to shorten the duration of perioperative management. [ABSTRACT FROM AUTHOR]

Abstract Background Blumgart pancreaticojejunostomy (PJ) was shown to be an effective method for pancreaticojejunostomy in open pancreaticoduodenectomy. But the original Blumgart method is involved in complicated and interrupted sutures, which may not be suitable for the laparoscopic approach. In this study, we introduced a simplified Blumgart method for laparoscopic pancreaticojejunostomy. Methods We retrospectively reviewed 90 cases of pancreaticoduodenectomy in our institute from 2019 to 2022. Among them, 32 patients received LPD with simplified Blumgart PJ, while 29 received LPD with traditional duct-to-mucosal anastomosis (the Cattel-Warren technique) and 29 received OPD with traditional duct-to-mucosal anastomosis. And the time length for PJ and the surgical outcome were compared in these three groups. Results The simplified Blumgart pancreaticojejunostomy was accomplished in all 32 cases with no conversion to open surgery due to improper sutures. And the time length for laparoscopic simplified Blumgart pancreaticojejunostomy was 26 ± 8.4 min, which was shorter than laparoscopic traditional ductal to mucosa pancreaticojejunostomy (39 ± 13.7 min). Importantly, the overall incidence for POPF and grade B&C POPF rate in the laparoscopic simplified Blumgart method group were 25% and 9.38% respectively, which were lower than the other two groups. Moreover, we performed univariate analysis and multivariate analysis and found soft pancreas, pancreatic ductal diameter

Abstract Background Laparoscopic pancreaticoduodenectomy(LPD) has become the goal of lots of minimally invasive surgical centers in recent years. Postoperative pancreatic fistula(POPF) is still the barrier to attaining the above goal. Thus, improving anastomosis techniques to reduce the rate of POPF has been a hotspot of surgery. Blumgart pancreaticojejunostomy is considered one of the best anastomosis procedures, with low rates of POPF. However, the original Blumgart pancreaticojejunostomy method is not easy for laparoscopic operation. In consequence, we modified a Blumgart pancreaticojejunostomy technique with a simple and practicable procedure and applied to LPD. Methods We collected and retrospectively analyzed the perioperative clinical data of patients who underwent modified Blumgart anastomosis from February 2017 to September 2022. The above patients included 53 cases in open pancreaticojejunostomy(OPD) and 58 cases in LPD. After propensity score matching, 44 cases were included for comparison in each group. Results After propensity score matching, the average time for pancreaticojejunostomy was about 30 min in the LPD group. The Clinically relevant POPF(CR-POPF) rate was 9.1%. The length of postoperative hospitalization was 13.1 days. Compared with the OPD group, The CR-POPF rate in the LPD group are not significant differences. But the postoperative length of hospital stay was significantly shorter in the LPD group. Besides, there were no other severely postoperative complications between two groups. Conclusion The modified Blumgart anastomosis technique applied to LPD in our Center not only has simple and convenient properties but also low rate of CR-POPF. And this method may be a good choice for surgeons to begin to carry out LPD.

Abstract Background and Objective It is controversial whether wrapping around the pancreaticojejunostomy (PJ) could reduce the rate of postoperative pancreatic fistula (POPF), especially in laparoscopic pancreaticoduodenectomy (LPD). This study aims to summarize our single-center initial experience in wrapping around PJ using the ligamentum teres hepatis (LTH) and demonstrate the feasibility and safety of this method. Methods Patients who underwent LPD applying the procedure of wrapping around the PJ were identified. The cohort was compared to the cohort with standard non-wrapping PJ. A 1:1 propensity score matching (PSM) was performed to compare the early postoperative outcomes of the two cohorts. Risk factors for POPF were determined by using univariate and multivariate logistic regression analysis. Results Overall, 143 patients were analyzed (LPD without wrapping (n = 91) and LPD with wrapping (n = 52)). After 1:1 PSM, 48 patients in each cohort were selected for further analysis. Bile leakage, DGE, intra-abdominal infection, postoperative hospital stays, harvested lymph nodes, and R0 resection were comparable between the two cohorts. However, the wrapping cohort was associated with significantly less POPF B (1 vs 18, P = 0.003), POPF C (0 vs 8, P = 0.043), and Clavien–Dindo classification level III–V (5 vs 26, P = 0.010). No patients died due to the clinically relevant POPF in the two cohorts. No patients who underwent the LTH wrapping procedure developed complications directly related to the wrapping procedure. After PSM, whether wrapping was an independent risk factor for POPF (OR = 0.202; 95%CI:0.080–0.513; P = 0.001). Conclusions Wrapping the LTH around the PJ technique for LPD was safe, efficient, and reproducible with favorable perioperative outcomes in selected patients. However, further validations using high-quality RCTs are still required to confirm the findings of this study.

Simple Summary: With ageing, the number of pancreaticoduodenectomies (PD) for benign or malignant disease is expected to increase in elderly patients. The aim of the present meta-analysis is to compare the surgical outcomes of MIPD in elderly versus younger patients. The results of our analysis disclose no considerable differences in terms of technical and post-operative outcomes between the two groups. However, slightly higher, but acceptable, major complication and mortality rates were recorded in the elderly cohort. Although the real additional value of minimally invasive surgery in this frailty subset of patients needs to be further investigated, our findings reveal that MIPD seems to be relatively safe and feasible in elderly patients. (1) Background: With ageing, the number of pancreaticoduodenectomies (PD) for benign or malignant disease is expected to increase in elderly patients. However, whether minimally invasive pancreaticoduodenectomy (MIPD) should be performed in the elderly is not clear yet and it is still debated. (2) Materials and Methods: A systematic review and meta-analysis was conducted including seven published articles comparing the technical and post-operative outcomes of MIPD in elderly versus younger patients up to December 2022. (3) Results: In total, 1378 patients were included in the meta-analysis. In term of overall and Clavien–Dindo I/II complication rates, post-operative pancreatic fistula (POPF) grade > A rates and biliary leakage, abdominal collection, post-operative bleeding and delayed gastric emptying rates, no differences emerged between the two groups. However, this study showed slightly higher intraoperative blood loss [MD 43.41, (95%CI 14.45, 72.38) p = 0.003], Clavien–Dindo ≥ III complication rates [OR 1.87, (95%CI 1.13, 3.11) p = 0.02] and mortality rates [OR 2.61, (95%CI 1.20, 5.68) p = 0.02] in the elderly compared with the younger group. Interestingly, as a minor endpoint, no differences in terms of the mean number of harvested lymphnode and of R0 resection rates were found. (4) Conclusion: MIPD seems to be relatively safe; however, there are slightly higher major morbidity, lung complication and mortality rates in elderly patients, who potentially represent the individuals that may benefit the most from the minimally invasive approach. [ABSTRACT FROM AUTHOR]

Background: The use of laparoscopic pancreaticoduodenectomy (LPD) in pancreatic head cancer remains controversial, and an appropriate surgical approach can help improve perioperative safety and oncological outcomes. This study aimed to assess the short-term outcomes and long-term survival of the superior mesenteric artery first (SMA-first) approach in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing LPD. Methods: The data of 91 consecutive PDAC patients who underwent LPD from June 2014 to June 2021 were retrospectively analyzed. Patients were divided into two groups, the modified SMA-first approach group, using a combined posterior and anterior approach, and the conventional approach group. Perioperative outcomes, pathologic results, and overall survival (OS) were compared between groups, and propensity score-matched (PSM) analysis was performed. Results: The number of lymph nodes harvested was greater in the SMA-first approach group (19 vs. 15, P = 0.021), as did the results in the matched cohort (21 vs. 15, P = 0.046). No significant difference was observed in the R0 resection rate (93.3% vs. 82.6%, P = 0.197), but the involvement of the SMA margin was indeed lower in the SMA-first approach group (0 vs. 13%). There were no obvious variances between the two groups in terms of intraoperative bleeding, operative time, overall and major postoperative complication rates, and mortality in either the original cohort or matched cohort. The median OS was 21.8 months in the SMA-first group, whereas it was 19.8 months in the conventional group (P = 0.900). Survival also did not differ in the matched cohort (P = 0.558). TNM stage, resection margin, overall complications, and adjuvant therapy were independent risk factors affecting OS. Conclusion: The modified SMA-first approach is safe and feasible for PDAC patients undergoing LPD. It had a slight advantage in specimen quality, but OS was not significantly prolonged. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic pancreaticoduodenectomy(LPD) has become the goal of lots of minimally invasive surgical centers in recent years. Postoperative pancreatic fistula(POPF) is still the barrier to attaining the above goal. Thus, improving anastomosis techniques to reduce the rate of POPF has been a hotspot of surgery. Blumgart pancreaticojejunostomy is considered one of the best anastomosis procedures, with low rates of POPF. However, the original Blumgart pancreaticojejunostomy method is not easy for laparoscopic operation. In consequence, we modified a Blumgart pancreaticojejunostomy technique with a simple and practicable procedure and applied to LPD. Methods: We collected and retrospectively analyzed the perioperative clinical data of patients who underwent modified Blumgart anastomosis from February 2017 to September 2022. The above patients included 53 cases in open pancreaticojejunostomy(OPD) and 58 cases in LPD. After propensity score matching, 44 cases were included for comparison in each group. Results: After propensity score matching, the average time for pancreaticojejunostomy was about 30 min in the LPD group. The Clinically relevant POPF(CR-POPF) rate was 9.1%. The length of postoperative hospitalization was 13.1 days. Compared with the OPD group, The CR-POPF rate in the LPD group are not significant differences. But the postoperative length of hospital stay was significantly shorter in the LPD group. Besides, there were no other severely postoperative complications between two groups. Conclusion: The modified Blumgart anastomosis technique applied to LPD in our Center not only has simple and convenient properties but also low rate of CR-POPF. And this method may be a good choice for surgeons to begin to carry out LPD. [ABSTRACT FROM AUTHOR]

Background: Blumgart pancreaticojejunostomy (PJ) was shown to be an effective method for pancreaticojejunostomy in open pancreaticoduodenectomy. But the original Blumgart method is involved in complicated and interrupted sutures, which may not be suitable for the laparoscopic approach. In this study, we introduced a simplified Blumgart method for laparoscopic pancreaticojejunostomy. Methods: We retrospectively reviewed 90 cases of pancreaticoduodenectomy in our institute from 2019 to 2022. Among them, 32 patients received LPD with simplified Blumgart PJ, while 29 received LPD with traditional duct-to-mucosal anastomosis (the Cattel-Warren technique) and 29 received OPD with traditional duct-to-mucosal anastomosis. And the time length for PJ and the surgical outcome were compared in these three groups. Results: The simplified Blumgart pancreaticojejunostomy was accomplished in all 32 cases with no conversion to open surgery due to improper sutures. And the time length for laparoscopic simplified Blumgart pancreaticojejunostomy was 26 ± 8.4 min, which was shorter than laparoscopic traditional ductal to mucosa pancreaticojejunostomy (39 ± 13.7 min). Importantly, the overall incidence for POPF and grade B&C POPF rate in the laparoscopic simplified Blumgart method group were 25% and 9.38% respectively, which were lower than the other two groups. Moreover, we performed univariate analysis and multivariate analysis and found soft pancreas, pancreatic ductal diameter < = 3 mm and intraoperative blood loss were independent risk factors for POPF after PD. Conclusion: Our data suggest that the simplified Blumgart method is a feasible and reliable method for laparoscopic PJ which deserves further validation. [ABSTRACT FROM AUTHOR]

Keywords: Laparoscopic pancreaticoduodenectomy; Pancreaticojejunostomy; Clinically relevant pancreatic fistula EN Laparoscopic pancreaticoduodenectomy Pancreaticojejunostomy Clinically relevant pancreatic fistula 2205 2208 4 10/18/23 20231001 NES 231001 Jia-Yi Wu and Yu Zheng contributed equally to this work. For anterior side of section B, we placed another 3-0 polypropylene suture through the anterior layer of the pancreatic parenchyma and anterior jejunum incision via the plastic catheter (Fig. D Anastomosis of section B1 was created between the anterior layer of the pancreatic parenchyma and anterior jejunum incision via the plastic catheter using another 3-0 Prolene, tightened the thread and finished with 1 stitch. [Extracted from the article]

Background: Augmented reality (AR)-assisted navigation system are currently good techniques for hepatectomy; however, its application and efficacy for laparoscopic pancreatoduodenectomy have not been reported. This study sought to focus on and evaluate the advantages of laparoscopic pancreatoduodenectomy guided by the AR-assisted navigation system in intraoperative and short-time outcomes. Methods: Eighty-two patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to May 2022 were enrolled and divided into the AR and non-AR groups. Clinical baseline features, operation time, intraoperative blood loss, blood transfusion rate, perioperative complications, and mortality were analyzed. Results: AR-guided laparoscopic pancreaticoduodenectomy was performed in the AR group (n =41), whereas laparoscopic pancreatoduodenectomy was carried out routinely in the non-AR group (n= 41). There was no significant difference in baseline data between the two groups (P> 0.05); Although the operation time of the AR group was longer than that of the non-AR group (420.15 ± 94.38 vs. 348.98 ± 76.15, P< 0.001), the AR group had a less intraoperative blood loss (219.51 ± 167.03 vs. 312.20 ± 195.51, P= 0.023), lower blood transfusion rate (24.4 vs. 65.9%, P <0.001), lower occurrence rates of postoperative pancreatic fistula (12.2 vs. 46.3%, P=0.002) and bile leakage (0 vs. 14.6%, P=0.026), and shorter postoperative hospital stay (11.29 ± 2.78 vs. 20.04 ± 11.22, P< 0.001) compared with the non-AR group. Conclusion: AR-guided laparoscopic pancreatoduodenectomy has significant advantages in identifying important vascular structures, minimizing intraoperative damage, and reducing postoperative complications, suggesting that it is a safe, feasible method with a bright future in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: Since the first successful open pancreaticoduodenectomy (OPD) that performed in 1935, several major landmarks have been achieved in the field such as the performance of the first laparoscopic pancreaticoduodenectomy (LPD) 28 years ago and the first robotic pancreaticoduodenectomy (RPD) 19 years ago. Numerous studies have justified the efficacy and safety of RPD and its popularity has been increasing significantly in recent years. As an updated technique, robotic system is superior to laparoscope with both theoretical and technical advantages.

Background/Purpose: Laparoscopic pancreaticoduodenectomy (PD) with major vein resection is a challenging procedure. Herein, we evaluated the feasibility and safety of laparoscopic vein resection in pancreatic head cancer with portal vein/superior mesenteric vein (PV/SMV) invasion, and compared the survival rate following laparoscopic surgery with that following open surgery. Methods: We retrospectively reviewed the electronic medical records of all patients with pancreatic head cancer who underwent surgery performed by a single surgeon from January 2015 to December 2017. Kaplan–Meier curves were plotted to compare the disease‐free survival, while Cox‐proportional hazard models were used to analyze prognostic factors for survival. Results: Among 76 patients, 63 underwent open PD and 13 underwent laparoscopic PD with PV/SMV resection. There was no significant difference in the rate of complications, including portal vein stenosis and portal vein thrombus, recurrence of tumors, or pathological outcomes after surgery between the groups. There was also no significant difference in disease‐free survival (p =.803) between the two groups. Additionally, the surgical method was not an independent prognostic factor for disease‐free survival. Conclusions: Laparoscopic PD with major vein resection can be feasibly performed in select patients with abutment and focal narrowing of the PV/SMV in pancreatic head cancer. [ABSTRACT FROM AUTHOR]

Background: The results of laparoscopic pancreaticoduodenectomy combining with mesentericoportal vein resection and reconstruction (LPD-MPVRs) for pancreatic head adenocarcinoma are rarely reported. The aim of present study was to explore the short- and long-term outcomes of different type of LPD-MPVRs. Methods: Patients who underwent LPD-MPVRs in 14 Chinese high-volume pancreatic centers between June 2014 and December 2020 were selected and compared. Results: In total, 142 patients were included and were divided into primary closure (n = 56), end-end anastomosis (n = 43), or interposition graft (n = 43). Median overall survival (OS) and median progress-free survival (PFS) between primary closure and end-end anastomosis had no difference (both P > 0.05). As compared to primary closure and end-end anastomosis, interposition graft had the worst median OS (12 months versus 19 months versus 17 months, P = 0.001) and the worst median PFS (6 months versus 15 months versus 12 months, P < 0.000). As compared to primary closure, interposition graft had almost double risk in major morbidity (16.3 percent versus 8.9 percent) and about triple risk (10 percent versus 3.6 percent) in 90-day mortality, while End-end anastomosis had only one fourth major morbidity (2.3 percent versus 8.9 percent). Multivariate analysis revealed postoperation hospital stay, American Society of Anesthesiologists (ASA) score, number of positive lymph nodes had negative impact on OS, while R0, R1 surgical margin had protective effect on OS. Postoperative hospital stay had negative impact on PFS, while primary closure, end-end anastomosis, short-term vascular patency, and short-term vascular stenosis positively related to PFS. Conclusions: In LPD-MPVRs, interposition graft had the worst OS, the worst PFS, the highest rate of major morbidity, and the highest rate of 90-day mortality. While there were no differences in OS and PFS between primary closure and end-end anastomosis. [ABSTRACT FROM AUTHOR]

Background: Pancreaticoduodenectomy (PD) is a complex operative procedure, which remains the primary curative treatment for pancreatic, distal bile duct, and periampullary cancers. In recent years, with the continuous development of laparoscopic technology and equipment, laparoscopic pancreaticoduodenectomy (LPD) has been performed gradually in many high-volume surgical centers. However, it is still challenging even for experienced pancreatic surgeons to perform LPD, at the same time, with the accumulation of surgical experience, different surgical approaches are also constantly discussed. Methods: We retrospectively analyzed the clinical data of 323 patients who received LPD at a single institution. Among them, 200 patients received operations with retrocolic approach, 123 patients were treated with traditional approach. In this study, we analyzed perioperative data and compared survival time for patients with pancreatic cancers in two groups. Result: Compared with traditional approach, retrocolic approach with uncinate process priority has a shorter operative time (94.25 ± 6.46 minutes versus 116.43 ± .4.78 minutes, P = .009) and less intraoperative blood loss (80 mL versus 150 mL, P = .562). However, there is no statistical significance in the incidence of postoperative complications (≥ Clavien-Dindo [CD] III) (65 [32.5%] versus 45 [36.58%], P = .871), R0 resection rates (41 versus 38, P = .826), and the number of lymph nodes harvested (16.64 ± 5.93 versus 15.37 ± 4.65, P = .785) between two groups. Meanwhile, the median survival time of patients with pancreatic cancers in posterior approach group was longer than those in traditional approach group (30.34 months versus 28.54 months, P > .05); however, there was no statistical significance between them. Conclusion: Retrocolic approach with uncinate process priority is a feasible method for pancreatic cancer, which could reduce operating time and intraoperative bleeding, meanwhile, not increase the incidence of postoperative complications. Retrocolic approach with uncinate process priority can be generalized to larger group sizes. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic pancreaticoduodenectomy (LPD) is gaining wide acceptance within pancreatic surgery. However, longitudinal data are lacking. The aim of this study was to analyze and assess the short-term outcomes and long-term survival of LPD over a duration of 8 years. Methods: Patients who underwent LPD in our institution between November 2013 and September 2021 were included in this study. The perioperative outcomes were statistically analyzed. The long-term survival was studied over a median follow-up duration of 13 months. Results: In total, 653 consecutive patients treated at our institution were included, of which 617 cases underwent standard LPD and 36 cases underwent LPD with vascular resection. The rate of death in hospital, reoperation, postpancreatectomy hemorrhage, postoperative pancreatic fistula, and delayed gastric emptying were 4.4%, 10.3%, 11.9%, 12.9%, and 6.1% respectively. There were statistical differences in the intraoperative blood loss and transfusion, operation time, and the R0 resection rate between the LPD cases and LPD with vascular resection cases. A total of 526 cases were pathologically diagnosed of cancer. The 1-, 3-, and 5-year survival rates were 49.2%, 17.9%, and 17.9%, respectively, for pancreatic cancer with the median survival time of 12 months. The 1-, 3-, and 5-year survival rates were 76.9%, 60.8%, and 52.5%, respectively, for bile duct cancer with the median survival time of 35 months. The 1-, 3-, and 5-year survival rates were 80.2%, 62.2%, and 52.9%, respectively, for duodenal cancer with the median survival time of 53 months. The 1-, 3-, and 5-year survival rates were 72.5%, 54.5%, and 50%, respectively, for ampullary cancer with the median survival time of 55 months. Conclusion: LPD is a feasible and oncologically acceptable procedure with satisfying perioperative outcomes and long-term survival in a high-volume institution. [ABSTRACT FROM AUTHOR]