Lee Sung Hwan, Kang Chang Moo, Hwang Ho Kyoung, Choi Sung Hoon, Lee Woo Jung, Chi Hoon Sang
Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Surg Endosc. 2014 Oct;28(10):2848-55. doi: 10.1007/s00464-014-3537-3. Epub 2014 May 23.
Although minimally invasive techniques for distal pancreatectomy with or without splenectomy have been regarded as a feasible and safe treatment option for benign and borderline malignant lesions of the pancreas, the management of left-sided pancreatic cancer remains controversial.
From June 2007 to November 2010, 12 patients underwent laparoscopic or robotic radical antegrade modular pancreatosplenectomy (RAMPS) for well-selected left-sided pancreatic cancer. The Yonsei criteria for patient selection included the following conditions: (1) tumor confined to the pancreas, (2) intact fascial layer between the distal pancreas and the left adrenal gland and kidney, and (3) tumor located more than 1-2 cm from the celiac axis. We compared the clinicopathologic factors and oncologic outcomes of the minimally invasive surgery (MIS) and the conventional open surgery groups for treating left-sided pancreatic cancer.
In the MIS group, the mean tumor size was 2.75 ± 1.32 cm, and the mean number of retrieved lymph nodes was 10.5 ± 7.14. The resection margins were confirmed to be negative for malignancy in all patients. The MIS group and open group (n = 78) were statistically different in terms of tumor size (2.8 ± 1.3 vs. 3.5 ± 1.9 cm, p = 0.05) and length of hospital stay (12.3 ± 6.8 vs. 22.4 ± 21.6 days, p = 0.002). On survival analysis, the MIS group had longer disease-free survival (DFS) and overall survival (OS) than the open group (DFS: 47.6 vs. 24.7 months, p = 0.027; OS: 60.0 vs. 30.7 months, p = 0.046). In order to overcome the heterogeneity of subjects between the MIS and the open group, we performed statically matched comparisons using the propensity score analysis and then divided the open group into two subgroups according to the Yonsei criteria. There were no significant differences in median overall survival between the MIS group and the open group that met the Yonsei criteria (60.00 vs. 60.72 months, p = 0.616).
Minimally invasive RAMPS is not only technically feasible but also oncologically safe in cases of well-selected left-sided pancreatic cancer. Our selection criteria for minimally invasive RAMPS needs to be further validated based on additional large-volume studies.
尽管保留或不保留脾脏的远端胰腺切除术的微创技术已被视为治疗胰腺良性和交界性恶性病变的一种可行且安全的治疗选择,但左侧胰腺癌的治疗仍存在争议。
2007年6月至2010年11月,12例患者因精心挑选的左侧胰腺癌接受了腹腔镜或机器人根治性顺行模块化胰脾切除术(RAMPS)。延世大学的患者选择标准包括以下条件:(1)肿瘤局限于胰腺;(2)胰腺远端与左肾上腺及肾脏之间的筋膜层完整;(3)肿瘤距离腹腔干轴超过1 - 2厘米。我们比较了微创外科手术(MIS)组和传统开放手术组治疗左侧胰腺癌的临床病理因素和肿瘤学结果。
在MIS组中,平均肿瘤大小为2.75±1.32厘米,平均回收淋巴结数为10.5±7.14。所有患者的切除边缘均证实无恶性肿瘤。MIS组与开放手术组(n = 78)在肿瘤大小(2.8±1.3对3.5±1.9厘米,p = 0.05)和住院时间(12.3±6.8对22.4±21.6天,p = 0.002)方面存在统计学差异。在生存分析中,MIS组的无病生存期(DFS)和总生存期(OS)均长于开放手术组(DFS:47.6对24.7个月,p = 0.027;OS:60.0对30.7个月,p = 0.046)。为了克服MIS组和开放手术组之间研究对象的异质性,我们使用倾向得分分析进行了静态匹配比较,然后根据延世大学标准将开放手术组分为两个亚组。符合延世大学标准的MIS组和开放手术组之间的中位总生存期无显著差异(60.00对60.72个月,p = 0.616)。
对于精心挑选的左侧胰腺癌病例,微创RAMPS不仅在技术上可行,而且在肿瘤学上是安全的。我们的微创RAMPS选择标准需要基于更多的大样本研究进一步验证。