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The short- and long-term outcomes of laparoscopic pancreaticoduodenectomy combining with different type of mesentericoportal vein resection and reconstruction for pancreatic head adenocarcinoma: a Chinese multicenter retrospective cohort study

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Abstract

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.

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Acknowledgements

The authors would like to acknowledge Man Zhang, Yifeng Liu, Hui Wang, Guangsheng Yu, Xiaolong Liu, Yigang Wang, and Xuehui Peng for assistance in following-up patients.

Funding

This study was supported by National Institutes of Health of China (Grant No. W2017ZWS07).

Author information

Author notes

  1. Guoqing Ouyang, Xiaosheng Zhong, Zhiwei Cai, Jianhua Liu, Shangyou Zheng, Defei Hong, Xinmin Yin, Jian Yu, Xueli Bai, Yahui Liu, Jun Liu, Xiaobing Huang, Yong Xiong, Jie Xu have contributed equally.

Authors and Affiliations

  1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, People’s Republic of China

    Guoqing Ouyang, Yunqiang Cai & Bing Peng

  2. Department of Pancreatic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People’s Republic of China

    Xiaosheng Zhong

  3. Department of Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, People’s Republic of China

    Zhiwei Cai & Zhongyi Jiang

  4. Department of Hepato-Pancreato-Biliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China

    Jianhua Liu

  5. Department of Pancreas Center, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, People’s Republic of China

    Shangyou Zheng & Rufu Chen

  6. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China

    Shangyou Zheng & Rufu Chen

  7. Department of General Surgery, Sir Run Run Shaw Hospital, The Medicine School of Zhejiang University, Hangzhou, Zhejiang, China

    Defei Hong

  8. Department of Hepatobiliary Surgery, The People’s Hospital of Hunan Province, Changsha, Hunan, People’s Republic of China

    Xinmin Yin

  9. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China

    Jian Yu & Xueli Bai

  10. Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, People’s Republic of China

    Yahui Liu

  11. Department of Live Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People’s Republic of China

    Jun Liu

  12. Department of Live Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China

    Jun Liu

  13. Department of Hepatobiliary Surgery, The Second Affiliated Army Medical University, Chongqing, People’s Republic of China

    Xiaobing Huang

  14. Department of Hepatobiliary Surgery, Panzhihua Central Hospital, Panzhihua, Sichuan, People’s Republic of China

    Yong Xiong

  15. Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China

    Jie Xu

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  1. Guoqing Ouyang
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  2. Xiaosheng Zhong
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Contributions

BP and GO: designed the study. GO, XZ, ZC, JL, SZ, DH, XY, JY, XB, YL, JL, XH, YX, JX, YC, ZJ and RC: collected and analyzed the data. GO: wrote the manuscript and all authors revised the manuscript. YC, ZJ, RC and BP: made the final approval of the version to be published.

Corresponding authors

Correspondence to Yunqiang Cai, Zhongyi Jiang, Rufu Chen or Bing Peng.

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Disclosures

Drs. Guoqing Ouyang, Xiaosheng Zhong, Zhiwei Cai, Jianhua Liu, Shangyou Zheng, Defei Hong, Xinmin Yin, Jian Yu, Xueli Bai, Yahui Liu, Jun Liu, Xiaobing Huang, Yong Xiong, Jie Xu, Yunqiang Cai, Zhongyi Jiang, Rufu Chen, and Bing Peng had no conflict of interests or financial ties to be disclosed.

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Ouyang, G., Zhong, X., Cai, Z. et al. The short- and long-term outcomes of laparoscopic pancreaticoduodenectomy combining with different type of mesentericoportal vein resection and reconstruction for pancreatic head adenocarcinoma: a Chinese multicenter retrospective cohort study. Surg Endosc 37, 4381–4395 (2023). https://doi.org/10.1007/s00464-023-09901-2

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