Laparoscopic versus open pancreaticoduodenectomy with major vein resection for pancreatic head cancer

Background/Purpose: Laparoscopic pancreaticoduodenectomy (PD) with major vein resection is a challenging procedure. Herein, we evaluated the feasibility and safety of laparoscopic vein resection in pancreatic head cancer with portal vein/superior mesenteric vein (PV/SMV) invasion, and compared the survival rate following laparoscopic surgery with that following open surgery.Methods: We retrospectively reviewed the electronic medical records of all patients with pancreatic head cancer who underwent surgery performed by a single surgeon from January 2015 to December 2017. Kaplan- Meier curves were plotted to compare the disease -free survival, while Cox-proportional hazard models were used to analyze prognostic factors for survival.Results: Among 76 patients, 63 underwent open PD and 13 underwent laparoscopic PD with PV/SMV resection. There was no significant difference in the rate of complications, including portal vein stenosis and portal vein thrombus, recurrence of tumors, or pathological outcomes after surgery between the groups. There was also no significant difference in disease -free survival (p = .803) between the two groups. Additionally, the surgical method was not an independent prognostic factor for disease -free survival.Conclusions: Laparoscopic PD with major vein resection can be feasibly performed in select patients with abutment and focal narrowing of the PV/SMV in pancreatic head cancer.

Automated summary

This study evaluated the feasibility and safety of laparoscopic vein resection in pancreatic head cancer with PV/SMV invasion, and compared the survival rate between laparoscopic surgery and open surgery. The results showed no significant differences in complications, tumor recurrence, pathological outcomes, and disease-free survival between the two groups. The surgical method was not an independent prognostic factor for disease-free survival.