Stauffer John A, Coppola Alessandro, Mody Kabir, Asbun Horacio J
Division of General Surgery, Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
World J Surg. 2016 Jun;40(6):1477-84. doi: 10.1007/s00268-016-3412-6.
Laparoscopic distal pancreatectomy (LDP) has been shown to have short-term benefits over open distal pancreatectomy (ODP). Its application for pancreatic ductal adenocarcinoma (PDAC) remains controversial.
From 1995 to 2014, 72 patients underwent distal pancreatectomy for PDAC at a single institution and were included in the study. Postoperative and long-term outcomes of patients undergoing LDP (n = 44) or ODP (n = 28) were compared.
LDP was associated with less blood loss (332 vs. 874 mL, p = 0.0012) and lower transfusion rates than ODP (18.2 vs. 50 %, p = 0.0495). Operative time was similar (254 vs. 266 min) for LDP and ODP; five patients (11.4 %) required conversion to ODP. Pancreatic fistulas (13.6 vs. 7.1 %) and major complications (13.6 vs. 25 %), were similar between LDP and ODP, respectively. Length of hospital stay (5.1 vs. 9.4 days, p = 0.0001) and time to initiate adjuvant therapy (69.4 vs. 95.6 days, p = 0.0441) was shorter for LDP than ODP. Tumor characteristics were similar but LDP was associated with more resected lymph nodes than ODP (25.9 vs. 12.7, p = 0.0001). One-, three-, and five-year survival rates were similar between LDP (69, 41, and 41 %, respectively) and ODP (78, 44, and 32 %, respectively).
LDP is associated with less blood loss and need for blood transfusion, shorter hospital stay, and faster time to initiate adjuvant therapy than ODP for patients with PDAC. Postoperative outcomes and long-term survival are similar between the two groups. LDP appears to be safe in the treatment of patients with PDAC.
与开放性远端胰腺切除术（ODP）相比，腹腔镜远端胰腺切除术（LDP）已显示出短期优势。其在胰腺导管腺癌（PDAC）中的应用仍存在争议。
1995年至2014年，72例患者在单一机构接受了针对PDAC的远端胰腺切除术并纳入本研究。比较了接受LDP（n = 44）或ODP（n = 28）患者的术后及长期结局。
与ODP相比，LDP术中失血量更少（332 vs. 874 mL，p = 0.0012），输血率更低（18.2% vs. 50%，p = 0.0495）。LDP和ODP的手术时间相似（254 vs. 266分钟）；5例患者（11.4%）需要转为ODP。LDP和ODP的胰瘘发生率（13.6% vs. 7.1%）和主要并发症发生率（13.6% vs. 25%）分别相似。LDP患者的住院时间（5.1 vs. 9.4天，p = 0.0001）和开始辅助治疗的时间（69.4 vs. 95.6天，p = 0.0441）比ODP患者短。肿瘤特征相似，但LDP切除的淋巴结比ODP多（25.9 vs. 12.7，p = 0.0001）。LDP组和ODP组的1年、3年和5年生存率分别相似（分别为69%、41%和41%与78%、44%和32%）。
对于PDAC患者，与ODP相比，LDP术中失血量更少、输血需求更少、住院时间更短且开始辅助治疗的时间更快。两组的术后结局和长期生存率相似。LDP在治疗PDAC患者中似乎是安全的。
