Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.503
Peer-review started: November 27, 2023
First decision: December 29, 2023
Revised: January 6, 2024
Accepted: February 5, 2024
Article in press: February 5, 2024
Published online: February 27, 2024
Although the en-bloc dissection of hepatic hilum lymph node shows many advantages in the radical treatment of several malignant tumors such as cholangiocarcinoma, periampullary carcinoma and pancreatic head cancer, the feasibility and safety of which for laparoscopic pancreaticoduodenectomy (LPD) require further clinical evaluation and investigation.
The motivation behind this article is to provide the emerging and valuable technique of the "five steps four quadrants" modularized en-bloc dissection in the field of hepatic hilum lymph node dissection of LPD.
The objective of this study is to explore the application value of the "five steps four quadrants" modularized en-bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.
A total of 52 patients who underwent LPD with the technique of "five steps four quadrants" modularized en-bloc dissection technique of hepatic hilum lymph node from April 2021 to July 2023 in our department were analyzed retro
There were 26 cases of pancreatic head cancer, 16 cases of periampullary cancer, and 10 cases of distal bile duct cancer. All patients successfully underwent the "five steps four quadrants" modularized en-bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage. Correlation analysis revealed significant associations between preoperative body mass index (BMI, r = 0.3581, P = 0.0091), total bilirubin (TBIL, r = 0.2988, P = 0.0341), prothrombin time (r = 0.3018, P = 0.0297) and lymph node dissection time. Moreover, dissection time was significantly correlated with intraoperative blood loss (r = 0.7744, P < 0.0001). Further stratified analysis demonstrated that patients with preoperative BMI ≥ 21.9 kg/m² and TBIL ≥ 57.7 μmol/L had significantly longer lymph node dissection time (both P < 0.05).
In general, the "five steps four quadrants" modularized en bloc dissection technique for hepatic hilum lymph nodes is safe and feasible for LPD.
This method is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve and thus is worthy of further clinical promotion and application.