[Strategy in management of adjacent organ lesion during laparoscopic pancreaticoduodenectomy].

Objective: To evaluate the safety and feasible of adjacent organ resection during laparoscopic pancreaticoduodenectomy(LPD), and summary the surgical strategies. Methods: Clinical data of 15 adjacent organ resections combined with LPD from March 2013 to September 2017 were reviewed.There were 10 male and 5 female patients aging from 20 to 86 years, and the body mass index ranged from 19.6 to 34.5 kg/m(2).Two patients had previous abdominal surgical history.Two patients underwent preoperative chemotherapy. Results: The resected adjacent organs included liver( n =4), stomach( n =3), colon( n =6), right kidney with embolectomy and vasoplastic of inferior vena cava( n =1), and spleen artery aneurysms( n =1). The operative time ranged from 280 to 450 minutes, and the blood loss ranged from 100 to 450 ml.The total complication rate was 5/15 and no one died in 90 days after surgery.The postoperative hospital stay ranged from 10 to 42 days with medium 18 days.The pathology included adenocarcinoma of stomach and duodenum( n =1), gastric cancer invading pancreas or duodenum( n =2), ampullary adenocarcinoma with left hepatolithiasis( n =1), ampullary adenocarcinoma with a benign lesion in left liver( n =1), ampullary adenocarcinoma with single liver metastasis( n =1), ampullary adenocarcinoma( n =1), pancreatic intraductal papillary mucinous neoplasm with splenic artery aneurysms( n =1), pancreatic neuroendocrine neoplasm with colon cancer( n =1), distal common bile duct adenocarcinoma involving righ hepatic duct( n =1), pancreatic neuroendocrine neoplasm invading inferior vena cava and right renal vein( n =1), duodenal adnocarcinoma( n =1), duodenal ewing's sarcoma( n =1), duodenal intesititialoma( n =2). The follow-up was from 3 to 40 months with the medium survival of 17.5 months. Conclusions: The oncological outcomes of PD combined with adjacent organ resection is acceptable.Surgical treatment for those patients with periampullary neoplasma and adjacent organ lesions should be aggressive.