Efficacy and safety of laparoscopic pancreaticoduodenectomy combined with a modified perioperative intraperitoneal chemotherapy regimen in resectable pancreatic head cancer: a dual-center retrospective cohort study.

[BACKGROUND] Surgical resection for pancreatic cancer is associated with high rates of locoregional recurrence and peritoneal metastasis, leading to poor prognosis. This study aimed to evaluate the safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) combined with a modified perioperative hyperthermic intraperitoneal chemotherapy (HIPEC) regimen for resectable pancreatic head cancer.

[METHODS] This dual-center retrospective cohort study included patients with resectable pancreatic head cancer who underwent LPD between May 2018 and July 2024. Patients were allocated to either the LPD-alone group (n=54) or the LPD plus HIPEC (LPD+HIPEC) group (n=55). The HIPEC protocol consisted of intraoperative hyperthermic saline perfusion, followed by intraperitoneal gemcitabine on postoperative day 2 and saline perfusion on day 4. The primary endpoint was overall survival (OS). Secondary endpoints included postoperative complications and patterns of recurrence. A multivariate Cox proportional hazards model was used to identify independent predictors of survival.

[RESULTS] A total of 109 patients were analyzed. Baseline demographic, clinical, and key oncologic characteristics were comparable between the two groups. The incidence of major postoperative complications (Clavien-Dindo grade ≥III) was not significantly different between the LPD+HIPEC and LPD groups (5.5% vs. 5.6%, P = 1.000). The LPD+HIPEC group had a significantly longer median OS (27 months; 95% CI, 24.1-29.9) compared to the LPD group (23 months; 95% CI, 20.5-25.5; P = 0.045). The 1-, 2-, and 3-year OS rates were 84.9%, 58.2%, and 26.3% in the LPD+HIPEC group, versus 74.6%, 40.0%, and 15.0% in the LPD group, respectively. Locoregional recurrence was significantly lower in the LPD+HIPEC group (14.6% vs. 31.5%, P = 0.035). On multivariate analysis, treatment with LPD+HIPEC was an independent predictor of improved OS (Hazard Ratio: 0.58; 95% CI: 0.35-0.97; P = 0.038).

[CONCLUSION] In this retrospective analysis, LPD combined with a modified perioperative HIPEC regimen was associated with improved overall survival and reduced locoregional recurrence rates for resectable pancreatic head cancer, without a significant increase in severe postoperative morbidity. These findings suggest a potential therapeutic role for this strategy, warranting further investigation in prospective randomized trials.