Comparison of laparoscopic versus open pancreaticoduodenectomy combined with portal vein/superior mesenteric vein resection and reconstruction for pancreatic cancer: a propensity score matching analysis

Background: Open surgery is gradually replaced by minimally invasive surgery, but few studies have reported the feasibility of laparoscopic pancreaticoduodenectomy (LPD) combined with vascular resection and reconstruction. The present study compared the efficacy of LPD with open pancreaticoduodenectomy (OPD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic cancer. Methods: The clinical data of patients who underwent PD combined with PV/SMV resection and reconstruction from March 2016 to August 2022 at our institution were retrospectively analyzed. The perioperative outcomes and survival outcomes were compared after propensity score matching (PSM). Results: The original cohort included 64 patients. Sixteen pairs of patients were obtained by 1:1 PSM. The intraoperative blood loss was greater in the OPD group than in the LPD group (550 vs . 200 mL, P=0.04), and the PV clamp time was longer in the LPD group than in the OPD group (29.4 vs . 18.8 min, P<0.001). There was no significant difference in the incidence of postoperative complications. The median overall survival and progression -free survival were comparable between the two groups (P>0.05). Conclusions: LPD combined with PV/SMV resection and reconstruction is safe and feasible in selected patients and results in similar perioperative outcomes and prognosis as open surgery.