Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 503-510
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.503
"Five steps four quadrants" modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in laparoscopic pancreaticoduodenectomy
Xiao-Si Hu, Yong Wang, Hong-Tao Pan, Chao Zhu, Shi-Lei Chen, Hui-Chun Liu, Qing Pang, Hao Jin
Xiao-Si Hu, Yong Wang, Hong-Tao Pan, Chao Zhu, Shi-Lei Chen, Hui-Chun Liu, Qing Pang, Hao Jin, Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People’s Hospital, Hefei 230041, Anhui Province, China
Co-corresponding authors: Qing Pang and Hao Jin.
Author contributions: Jin H and Pang Q contributed to the study concepts and design; Hu XS and Pang Q contributed to the manuscript preparation; Wang Y and Pan HT helped to perform the statistical analysis and the literature research; Zhu C and Chen SL contributed to data collection and analysis; Liu HC and Jin H edited the manuscript.
Supported by Health Research Program of Anhui, No. AHWJ2022b032.
Institutional review board statement: This study received approval from the Ethics Committee of Anhui No. 2 Provincial People’s Hospital (approval No. 2022-011).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to operation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing Pang, MD, PhD, Professor, Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People’s Hospital, No. 1868 Dangshan Road, North Second Ring Road, Yaohai District, Hefei 230041, Anhui Province, China. portxiu2@126.com
Received: November 27, 2023
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
Processing time: 90 Days and 12.1 Hours
Abstract
BACKGROUND

Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment, the feasibility and safety of this approach for laparoscopic pancreaticoduodenectomy (LPD) require further clinical evaluation and investigation.

AIM

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.

METHODS

A total of 52 patients who underwent LPD via the "five steps four quadrants" modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively. The patients' body mass index (BMI), preoperative laboratory indices, intraoperative variables and postoperative complications were recorded. The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.

RESULTS

Among the 52 patients, 36 were males and 16 were females, and the average age was 62.2 ± 11.0 years. There were 26 patients with pancreatic head cancer, 16 patients with periampullary cancer, and 10 patients with distal bile duct cancer. The BMI was 22.3 ± 3.3 kg/m², and the median total bilirubin (TBIL) concentration was 57.7 (16.0-155.7) µmol/L. 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 BMI (r = 0.3581, P = 0.0091), TBIL level (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 a preoperative BMI ≥ 21.9 kg/m² and a TIBL concentration ≥ 57.7 μmol/L had significantly longer lymph node dissection times (both P < 0.05).

CONCLUSION

The "five steps four quadrants" modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD. This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve; thus, it is worthy of further clinical promotion and application.

Keywords: Five steps four quadrants; Hepatic hilum lymph node; Modularized en bloc clearance; Laparoscopic pancreaticoduodenectomy

Core Tip: Although en bloc dissection of hepatic hilum lymph nodes has many advantages, the feasibility and safety of this approach for laparoscopic pancreaticoduodenectomy (LPD) requires further clinical investigation. We showed that the emerging technique of "five steps four quadrants" modularized en bloc dissection of hepatic hilum lymph nodes is safe and feasible for LPD. In this technique, a preoperative elevated body mass index, total bilirubin concentration, and prothrombin time increase the difficulty of lymph node dissection. This approach is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve; thus, this technique is worthy of further clinical promotion and application.