Hu XS, Wang Y, Pan HT, Zhu C, Chen SL, Liu HC, Pang Q, Jin H. "Five steps four quadrants" modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in laparoscopic pancreaticoduodenectomy. World J Gastrointest Surg 2024; 16(2): 503-510 [PMID: 38463365 DOI: 10.4240/wjgs.v16.i2.503]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 byHealth 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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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 retrospectively.
Research results
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).
Research conclusions
In general, the "five steps four quadrants" modularized en bloc dissection technique for hepatic hilum lymph nodes is safe and feasible for LPD.
Research perspectives
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.
