Laparoscopic versus open pancreaticoduodenectomy combined with uncinated process approach: A comparative study evaluating perioperative outcomes (Retrospective cohort study)

Background: Few studies on the uncinate process-first approach in laparoscopic pancreaticoduodenectomy (LPD) have been reported. The aim of this study is to compare the perioperative outcomes of LPD to open pancreaticoduodenectomy (OPD) in terms of feasibility, safety, and efficacy using the uncinate process-first approach. Materials and methods: This retrospective study included 102 patients who underwent pancreaticoduodenectomy between 2013 and 2017. Patients were divided into two groups based on the surgical approach: the laparoscopic surgery group (n= 47) and open surgery group (n= 55). The clinical characteristics and intra-and postoperative data were retrospectively analysed. Results: LPD was performed successfully in all 47 patients. The mean operation time was significantly longer in the LPD group (410 +/- 68 min) than in the OPD group (245 +/- 70 min; P < 0.05). LPD produced significantly less intraoperative blood loss (210 +/- 46 mL vs 420 +/- 50 mL, P < 0.05), shorter first flatus time (1.5 d vs 4 d, P < 0.05) and shorter diet start time (2 d vs 5 d, P < 0.05). The total hospital stay was significantly shorter in the LPD group, with a median of 13 +/- 4 days versus 18 +/- 5.5 days in the OPD group (P < 0.05). The post-operative complication rates of the LPD group and OPD group were 21.3% and 27.3%, respectively (P > 0.05). The rate of category I-II complications and rate of category III-IV complications did not significantly differ (P > 0.05). Pancreatic fistulae occurred in 6 patients (12.8%) in the LPD group and 8 patients (14.5%) in the OPD group (P= 0.67). Delayed gastric emptying occurred in 2 patients (4.26%) in the LPD group and 2 patients in the OPD group (3.63%; P= 0.79). Postpancreatectomy haemorrhage was not significantly different between the groups (2.13% vs 3.63%; P= 0.66). Conclusion: LPD with the uncinate process-first approach combines the benefits of laparoscopy with a low risk of postoperative complications and high rate of curative resection.