15. Kết quả gần phẫu thuật nội soi cắt khối tá tụy theo hướng tiếp cận từ phía bên trái động mạch mạc treo tràng trên trước tiên

Abstract

The utilization of laparoscopic pancreaticoduodenectomy (LPD) and superior mesenteric artery (SMA) first approach from the left side in open PD has demonstrated efficacy in facilitating early postoperative recovery and achieving a higher R0 resection rate. This study aims to assess the feasibility of integrating the left-sided SMA first approach in LPD. A prospective, non-controlled interventional study evaluated the recent outcomes of 37 patients diagnosed with the periampullary cancers in the resectable stage between January 2021 and December 2023, who underwent LPD with a left-sided SMA first approach. Findings indicated intraoperative complications occurring in 10.8% of cases (including 5.4% middle colic artery injuries, 2.7% portal vein injuries, and 2.7% mesenteric vein injuries), conversion to open surgery in 2.7%, postoperative pancreatic fistula in 24.3% (including 2.7% grade B pancreatic fistula), postoperative bleeding in 10.8%, delayed gastric emptying in 5.4%, chylous fistula in 18.9%, Clavien-Dindo grade III or higher complications in 10.8% of cases, with no mortality or severe morbidity. The mean hospital stay duration was 14.3 days. In conclusion, LPD with a left-sided SMA first approach demonstrates initial feasibility, with a low incidence of intraoperative and postoperative complications of grade III or higher. However, further research involving comparative controlled studies is warranted to derive more precise conclusions.