Survival Outcomes of Laparoscopic Pancreaticoduodenectomy with Arterial Circumferential Lymphadenectomy and Total Meso-pancreas Dissection for Periampullary Malignancies

Abstract

Backgrounds. The purpose of this study is to evaluate the survival outcomes, recurrence pattern and risk factors of patients with resectable periampullary malignancies (PM) underwent laparoscopic pancreaticoduodenectomy (LPD) with left-sided superior mesenteric artery (SMA) first-approach, circumferential lymphadenectomy around SMA and common hepatic artery (CHA) combined total meso-pancreas dissection (TMpD). Methods. This prospective study included 37 patients who underwent LPD for resectable PMs. General characteristics, operative techniques, pathological results, and survival outcomes including recurrence pattern were prospectively evaluated. Results. The median age of 58,95 ± 8,9 years (range 35–70), with fifty-four-point one percent of the patients are aged over 60 years. The mean operative time was totally 426,2 ± 78,5 (250–600) minutes. Metastatic meso-pancreas was observed in 11 cases (29,7%), and 17 cases (45,9%) had reactive fibrous tissue. The number of harvested lymph nodes (LNs) and left-sided SMA LNs were 32,4 ± 12,2 (16–74) and 7,1 ± 5,6 (1–30), respectively. The rate of metastatic left sided SMA LNs was 5 cases (13,5%). In multivariate analysis, the left sided SMA LNs metastasis status was the sole significant factor of both DFS and OS (p < 0.1). Conclusion. LPD with left-sided SMA first-approach, circumferential lymphadenectomy around SMA and CHA combined TMpD was effective to achieve favorable oncological and survival outcomes.