Baker Marshall S, Bentrem David J, Ujiki Michael B, Stocker Susan, Talamonti Mark S
Department of Surgery, Pritzker School of Medicine, University of Chicago, NorthShore University HealthSystem Campus, Evanston, IL 60201, USA.
Surgery. 2009 Oct;146(4):635-43; discussion 643-5. doi: 10.1016/j.surg.2009.06.045.
Laparoscopic distal pancreatectomy (LP) is an emerging modality for managing benign and premalignant neoplasms of the pancreatic body and tail. The efficacy of LP has been examined in single and multi-institutional retrospective reviews but not compared prospectively to open distal pancreatectomy (ODP).
We maintain a prospectively accruing database tracking peri-operative clinical parameters for all patients presenting to our tertiary care facility for treatment of pancreatic disease. We queried this database for patients undergoing LP or ODP between January 2003 and May 2008. Preoperative, operative, and postoperative characteristics were compared using standard statistical methods.
One-hundred twelve patients underwent distal pancreatectomy. Eighty-five underwent SDP. Twenty-eight LPs were attempted and 27 completed laparoscopically. One LP was converted to an open procedure because of bleeding and was excluded from study. In comparison to ODP, patients undergoing LP had statistically similar pre-operative demographics, disease comorbidities, tumor size, length of operation, rates of postoperative mortality, postoperative morbidity, and pancreatic fistula. Patients undergoing LP were less likely to have ductal adenocarcinoma and had fewer lymph nodes harvested in their resection but had a significantly shorter postoperative length of stay and significantly lower estimated blood loss than those undergoing ODP.
Laparoscopic distal pancreatectomy is a safe, effective modality for managing premalignant neoplasms of the pancreatic body and tail, providing a morbidity rate comparable to that for ODP and substantially shorter length of stay. Laparoscopic distal pancreatectomy fails to provide a lymphadenectomy comparable to ODP. This may limit the applicability of LP to the treatment of pancreatic adenocarcinoma.
腹腔镜胰体尾远端切除术（LP）是一种用于治疗胰体尾良性和癌前肿瘤的新兴术式。LP的疗效已在单机构和多机构回顾性研究中得到检验，但尚未与开放性胰体尾远端切除术（ODP）进行前瞻性比较。
我们维护了一个前瞻性收集数据的数据库，跟踪所有到我们三级医疗中心治疗胰腺疾病的患者的围手术期临床参数。我们查询该数据库，找出2003年1月至2008年5月期间接受LP或ODP的患者。使用标准统计方法比较术前、术中和术后特征。
112例患者接受了胰体尾远端切除术。85例行标准胰体尾远端切除术。尝试了28例LP，其中27例成功完成腹腔镜手术。1例LP因出血中转开放手术，被排除在研究之外。与ODP相比，接受LP的患者在术前人口统计学、疾病合并症、肿瘤大小、手术时间、术后死亡率、术后发病率和胰瘘发生率方面在统计学上相似。接受LP的患者患导管腺癌的可能性较小，切除术中清扫的淋巴结较少，但术后住院时间明显较短，估计失血量明显低于接受ODP的患者。
腹腔镜胰体尾远端切除术是治疗胰体尾癌前肿瘤的一种安全、有效的术式，其发病率与ODP相当，住院时间明显缩短。腹腔镜胰体尾远端切除术未能提供与ODP相当的淋巴结清扫。这可能会限制LP在胰腺癌治疗中的应用。
