Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 689-699
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.689
Comparison of prognosis and postoperative morbidities between standard pancreaticoduodenectomy and the TRIANGLE technique for resectable pancreatic ductal adenocarcinoma
He-Xing Hang, Zheng-Hua Cai, Yi-Fei Yang, Xu Fu, Yu-Dong Qiu, Hao Cheng
He-Xing Hang, Zheng-Hua Cai, Yi-Fei Yang, Xu Fu, Yu-Dong Qiu, Hao Cheng, Division of Pancreatic Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Co-first authors: He-Xing Hang and Zheng-Hua Cai.
Co-corresponding authors: Yu-Dong Qiu and Hao Cheng.
Author contributions: Hang HX, Cai ZH, Qiu YD, and Cheng H conceived, designed, and refined the study protocol; Hang HX, Cai ZH, and Cheng H acquired and analyzed the data; Hang HX, Cai ZH, and Qiu YD wrote the actual manuscript; Yang YF contributed to the data analyses; Fu X provided clinical advice; Qiu YD and Cheng H supervised the report and provided the funding acquisition; and all authors have read and approved the final version. Hang HX and Cai ZH contributed equally to this work as co-first authors; Qiu YD and Cheng H contributed equally to this work as co-corresponding authors. There are two reasons for this designation. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper’s quality and reliability. Second, Hang HX and Cai ZH contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledge and respect this equal contribution while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Hang HX and Cai ZH as co-first authors/Qiu YD and Cheng H as co-corresponding authors is appropriate for our manuscript, as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity.
Supported by the National Natural Science Foundation of China, No. 31971518.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Nanjing Drum Tower Hospital (approval No. 2021-437-01).
Informed consent statement: Data was de-identified and retrospectively collected, and therefore informed consent was not required from each patient.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Yu-Dong Qiu, Doctor, MD, PhD, Chief Physician, Professor, Division of Pancreatic Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. yudongqiunj@163.com
Received: December 19, 2023
Peer-review started: December 19, 2023
First decision: January 4, 2024
Revised: January 17, 2024
Accepted: February 21, 2024
Article in press: February 21, 2024
Published online: March 27, 2024
Processing time: 93 Days and 21.9 Hours
Abstract
BACKGROUND

Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocarcinoma (PDAC), although tumor recurrence, especially locally, still inhibits the treatment efficacy. The TRIANGLE technique was introduced as an extended dissection procedure to improve the R0 resection rate of borderline resectable or locally advanced PDAC. However, there was a lack of studies concerning postoperative complications and long-term outcomes of this procedure on patients with resectable PDAC.

AIM

To compare the prognosis and postoperative morbidities between standard pancreaticoduodenectomy (PD) and the TRIANGLE technique for resectable PDAC.

METHODS

Patients with resectable PDAC eligible for PD from our hospital between June 2018 and December 2021 were enrolled in this retrospective cohort study. All the patients were divided into PDstandard and PDTRIANGLE groups according to the surgical procedure. Baseline characteristics, surgical data, and postoperative morbidities were recorded. All of the patients were followed up, and the date and location of tumor recurrence, and death were recorded. The Kaplan-Meier method and log-rank test were used for the survival analysis.

RESULTS

There were 93 patients included in the study and 37 underwent the TRIANGLE technique. Duration of operation was longer in the PDTRIANGLE group compared with the PDstandard group [440 (410-480) min vs 320 (265-427) min] (P = 0.001). Intraoperative blood loss [700 (500-1200) mL vs 500 (300-800) mL] (P = 0.009) and blood transfusion [975 (0-1250) mL vs 400 (0-800) mL] (P = 0.009) were higher in the PDTRIANGLE group. There was a higher incidence of surgical site infection (43.2% vs 12.5%) (P = 0.001) and postoperative diarrhea (54.1% vs 12.5%) (P = 0.001) in the PDTRIANGLE group. The rates of R0 resection and local recurrence, overall survival, and disease-free survival did not differ significantly between the two groups.

CONCLUSION

The TRIANGLE technique is safe, with acceptable postoperative morbidities compared with standardized PD, but it does not improve prognosis for patients with resectable PDAC.

Keywords: Pancreatic ductal adenocarcinoma; TRIANGLE technique; Pancreaticoduodenectomy; Prognosis; Postoperative morbidities

Core Tip: We compared the prognosis and postoperative morbidities between standard pancreaticoduodenectomy and the TRIANGLE technique for resectable pancreatic ductal adenocarcinoma (PDAC). The TRIANGLE technique was safe and feasible, with acceptable postoperative complications, and improved the extent of radical resection. However, longer duration of operation, more intraoperative blood loss and higher incidence of postoperative diarrhea indicated that TRIANGLE technique was a more aggressive procedure. Local recurrence, disease-free survival and overall survival did not differ between the two groups. These results suggest that the TRIANGLE technique is not necessary for all resectable PDAC patients.