The comparation of short-term outcome between laparoscopic and open pancreaticoduodenectomy: a propensity score matching analysis

Abstract

Pancreaticoduodenectomy (PD) is one of the most complex and delicate operations in abdominal surgery. With the development of laparoscopic techniques, more and more pancreatic experts have become skilled in laparoscopic pancreaticoduodenectomy (LPD). However, the short-term efficacy of LPD compared to open pancreaticoduodenectomy (OPD) remains unclear. Here, we performed a propensity score matching study aiming to compare the short outcomes of patients who underwent LPD or OPD after the learning curve and established a risk model of pancreatic fistula. The data of 346 patients who had OPD or LPD from July 2015 to January 2020 were retrieved. After a 1:1 matching, 224 patients remained. The operation time was significantly longer (P = 0.001) but the amount of bleeding was significantly lower (P = 0.001) in the LPD group than in the OPD group. Patients in LPD group had fewer blood transfusions (P = 0.002) than those in OPD group. More lymph nodes (P < 0.001) were dissected in LPD group. The rate of grade B/C pancreatic fistula was significantly higher in the LPD group than in the OPD group (16.1% vs. 6.3%, P = 0.002). By multi variate Logistic regression analysis, we identified pancreatic tumor, malignancy and low body mass index were risk factors of Grade B/C pancreatic fistula after PD operation. Then, we developed a Grade B/C pancreatic fistula nomogram with the risk factors. The C-index of the nomogram was 0.836 (95% CI 0.762–0.910). In conclusion, LPD could be technically feasible, get less trauma and achieve similar short-term outcome as compared with OPD.

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The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

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Funding

This work was supported by Young Talent Development Plan of Changzhou Health Commission (CZQM2020118), the Development Foundation of Affiliated Hospital of Xuzhou Medical University (XYFY2020016), the Clinical Technology Development Foundation of Jiangsu University (JLY20180079), Post-Doctoral Special Foundation of China (2020M670065ZX), Post-Doctoral Foundation of Jiangsu Province (2020Z021), the National Natural Science Foundation of China (81971504).

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Correspondence to Donglin Sun or Yunjie Lu or Xuezhong Xu.

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Ding, W., Wu, W., Tan, Y. et al. The comparation of short-term outcome between laparoscopic and open pancreaticoduodenectomy: a propensity score matching analysis. Updates Surg (2021). https://doi.org/10.1007/s13304-021-00997-6

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Keywords

  • Laparoscopic pancreaticoduodenectomy (LPD)
  • Open pancreaticoduodenectomy (OPD)
  • Pancreatic fistula
  • Outcome
  • Propensity score matching analysis