Sharpe Susan M, Talamonti Mark S, Wang Edward, Bentrem David J, Roggin Kevin K, Prinz Richard A, Marsh Robert D W, Stocker Susan J, Winchester David J, Baker Marshall S
Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Department of Surgery, NorthShore University HealthSystems, Evanston, IL, USA.
Am J Surg. 2015 Mar;209(3):557-63. doi: 10.1016/j.amjsurg.2014.11.001. Epub 2014 Dec 17.
The oncologic equivalence of laparoscopic distal pancreatectomy (LDP) to open pancreatectomy (ODP) for ductal adenocarcinoma (DAC) is not established.
The National Cancer Data Base was used to compare perioperative outcomes following LDP and ODP for DAC between 2010 and 2011.
One hundred forty-five patients underwent LDP; 625 underwent ODP. Compared with ODP, patients undergoing LDP were older (68 ± 10.1 vs 66 ± 10.5 years, P = .027), more likely treated in academic centers (70% vs 59%, P = .01), and had shorter hospital stays (6.8 ± 4.6 vs 8.9 ± 7.5 days, P < .001). Demographic data, lymph node count, 30-day unplanned readmission, and 30-day mortality were identical between groups. Multivariable regression identified a lower probability of prolonged length of stay with LDP (odds ratio .51, 95% confidence interval .327 to .785, P = .0023). There was no association between surgical approach and node count, readmission, or mortality.
LDP for DAC provides shorter postoperative lengths of stay and rates of readmission and 30-day mortality similar to OPD without compromising perioperative oncologic outcomes.
腹腔镜远端胰腺切除术（LDP）与开放性胰腺切除术（ODP）治疗导管腺癌（DAC）的肿瘤学等效性尚未确立。
利用国家癌症数据库比较2010年至2011年间LDP和ODP治疗DAC后的围手术期结果。
145例患者接受了LDP；625例接受了ODP。与ODP相比，接受LDP的患者年龄更大（68±10.1岁对66±10.5岁，P = 0.027），在学术中心接受治疗的可能性更高（70%对59%，P = 0.01），住院时间更短（6.8±4.6天对8.9±7.5天，P < 0.001）。两组间的人口统计学数据、淋巴结计数、30天非计划再入院率和30天死亡率相同。多变量回归显示LDP导致住院时间延长的可能性较低（优势比0.51，95%置信区间0.327至0.785，P = 0.0023）。手术方式与淋巴结计数、再入院率或死亡率之间无关联。
LDP治疗DAC术后住院时间更短，再入院率和30天死亡率与OPD相似，且不影响围手术期肿瘤学结果。
