Department of Laparoscopic and Robotic Surgery, Azienda Ospedaliera dei Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
Surg Endosc. 2013 Jun;27(6):2131-6. doi: 10.1007/s00464-012-2728-z. Epub 2013 Jan 26.
Laparoscopic pancreatic surgery has gradually expanded its applications to include pancreaticoduodenectomy. However, the benefits of the laparoscopic approach are still debated. This article aims to present data regarding the efficacy of laparoscopic pancreaticoduodenectomy in a single center.
From March 2003 to June 2010, a total of 22 patients underwent pancreaticoduodenectomy with a totally laparoscopic approach, using a five-trocar technique. Reconstruction of the digestive tract was adapted to the aspect of the pancreatic stump, with 6 patients having Wirsung duct occlusion and 16 patients pancreaticodigestive anastomosis. Patient selection, short-term outcomes, oncologic results, and technical issues were retrospectively reviewed.
Mean operative time was 392 (range, 327-570) min. Conversion was required in 2 patients (9.1 %) as a result of bleeding and difficult dissection. Major intraoperative complications included an injury to the right hepatic artery (4.5 %). Postoperative mortality was 4.5 %. Surgery-related morbidity occurred in 14 patients (63.6 %) and included bleeding (n = 5), pancreatic fistula (n = 6), biliary fistula (n = 2), and dumping syndrome (n = 1). Pancreatic fistulas occurred in 4 patients with duct occlusion and in 2 patients with pancreaticojejunostomy, and they all healed with conservative treatment. Mean hospital stay was 23 (range, 12-35) days. Pathologic diagnoses were pancreatic ductal adenocarcinoma (n = 11), ampullary adenocarcinoma (n = 8), and duodenal adenocarcinoma (n = 3). The resection margins were all free from disease; the mean number of collected lymph nodes was 15 (range, 14-20).
The complexity of pancreaticoduodenectomy entails some issues, including patient selection and management of the pancreatic stump, that are not related to the approach used. Laparoscopic pancreaticoduodenectomy is feasible, safe, and oncologically adequate, but only if performed in selected cases by highly skilled laparoscopic surgeons. Laparoscopy does not provide any significant advantage over traditional surgery, but it may improve postoperative outcomes in the so-called excellence centers, once the learning curve has been overcome. Multicenter randomized trials are needed.
腹腔镜胰腺手术已逐渐扩展到包括胰十二指肠切除术。然而，腹腔镜方法的优势仍存在争议。本文旨在介绍单中心腹腔镜胰十二指肠切除术的疗效数据。
2003 年 3 月至 2010 年 6 月，共 22 例患者采用五孔技术行全腹腔镜胰十二指肠切除术。消化道重建适应胰腺残端的情况，其中 6 例行 Wirsung 导管闭塞，16 例行胰肠吻合术。回顾性分析患者选择、短期结果、肿瘤学结果和技术问题。
平均手术时间为 392（范围 327-570）分钟。由于出血和难以分离，2 例（9.1%）患者需要转换。术中主要并发症包括右肝动脉损伤（4.5%）。术后死亡率为 4.5%。与手术相关的发病率发生在 14 例患者（63.6%），包括出血（n=5）、胰瘘（n=6）、胆瘘（n=2）和倾倒综合征（n=1）。行导管闭塞的 4 例患者和行胰肠吻合术的 2 例患者发生胰瘘，均经保守治疗治愈。平均住院时间为 23（范围 12-35）天。病理诊断为胰腺导管腺癌（n=11）、壶腹腺癌（n=8）和十二指肠腺癌（n=3）。切缘均无肿瘤累及；收集的淋巴结平均数量为 15（范围 14-20）个。
胰十二指肠切除术的复杂性包括与手术方式无关的患者选择和胰腺残端的处理等问题。腹腔镜胰十二指肠切除术是可行的、安全的、肿瘤学上是足够的，但只有在高度熟练的腹腔镜外科医生的选择病例中才能进行。腹腔镜与传统手术相比没有明显优势，但一旦克服了学习曲线，它可能会改善所谓的卓越中心的术后结果。需要多中心随机试验。
