Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Ann Surg Oncol. 2011 May;18(5):1335-41. doi: 10.1245/s10434-010-1503-4. Epub 2011 Jan 5.
Given the difficulty level of minimally invasive pancreatoduodenectomy (MIPD), limited data exist for a comparison to open pancreatoduodenectomies. As the technique becomes more diffuse, issues regarding the adequacy of oncologic margins and lymph node retrieval need to be addressed.
All published cases of MIPD were examined. Variables analyzed included conversion rates, operating room time, estimated blood loss, length of stay, follow-up, complications, mortality, lymph node retrieval, and margins.
Twenty-seven articles describing outcomes after MIPD were found, and a total of 285 cases were described. Main malignancy treated was pancreatic adenocarcinoma, accounting for 32% of all cases. Eighty-seven percent were performed totally laparoscopically, and 13% were performed with a hand-assisted approach to facilitate the reconstruction step of the procedure. The rate of conversion to an open procedure was 9%. Estimated blood loss had a weighted average (WA) of 189 mL. Average length of stay had a WA of 12 days, and average follow-up had a WA of 14 months. The overall complication rate was 48%, and the overall mortality rate was 2%. Average lymph nodes retrieved ranged from 7 to 36 nodes, with a WA of 15 nodes, and positive margins of resection were reported to be positive in 0.4% of patients with malignant disease.
This review found similar outcomes with respect to perioperative morbidity and mortality rates compared to open pancreatoduodenectomies. The oncologic goals of pancreatic resection may be able to be achieved by MIPD, but longer follow-up and larger series are still needed.
鉴于微创胰十二指肠切除术（MIPD）的难度水平，与开腹胰十二指肠切除术相比，目前的数据有限。随着该技术的普及，需要解决关于肿瘤切缘和淋巴结检出的充分性问题。
检查了所有发表的 MIPD 病例。分析的变量包括转换率、手术室时间、估计失血量、住院时间、随访、并发症、死亡率、淋巴结检出和切缘。
共发现 27 篇描述 MIPD 术后结果的文章，共描述了 285 例病例。主要治疗的恶性肿瘤是胰腺腺癌，占所有病例的 32%。87%的病例完全采用腹腔镜进行，13%的病例采用手助方法进行，以促进手术的重建步骤。转为开腹手术的比例为 9%。估计失血量的加权平均值（WA）为 189ml。平均住院时间的 WA 为 12 天，平均随访时间的 WA 为 14 个月。总的并发症发生率为 48%，总的死亡率为 2%。平均检出的淋巴结数从 7 到 36 个不等，WA 为 15 个，恶性疾病患者的切除切缘阳性率为 0.4%。
与开腹胰十二指肠切除术相比，本综述发现 MIPD 在围手术期发病率和死亡率方面具有相似的结果。MIPD 可能能够实现胰腺切除术的肿瘤学目标，但仍需要更长的随访时间和更大的系列研究。
