Gabriel Emmanuel, Thirunavukarasu Pragatheeshwar, Attwood Kristopher, Nurkin Steven J
Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
Surg Endosc. 2017 Jan;31(1):398-409. doi: 10.1007/s00464-016-4987-6. Epub 2016 Jul 13.
For patients with pancreatic tumors, several disparities have been shown to impact access to care, including surgery, and subsequently adversely affect long-term oncologic outcomes. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS) across different demographics for pancreatic tumors.
We utilized the American College of Surgeons (ACS) National Cancer Data Base (NCDB) to identify patients with pancreatic tumors from 2010 to 2011 who had undergone surgery through either an open or MIS approach. Multivariable analysis was performed to investigate differences in patient characteristics in relation to surgical approach and conversion to open.
A total of 2809 patients were identified. The initial surgical approach included 86.5 % open (2430) and 13.5 % MIS (87.6 % were laparoscopic, and 12.4 % were robotic). Tumor histology was significantly associated with MIS, whereby patients with neuroendocrine tumors were more than twice as likely to have an MIS approach compared to adenocarcinoma. Tumor location within the pancreas was also associated with MIS, with tumors in the tail being three times more likely to be removed through MIS compared to tumors in the head. For patients with disease in the body or tail of the pancreas, ethnicity was independently associated with MIS whereby patients of Hispanic origin were less likely to have MIS. The conversion rate to open was 27.7 %, and geographic location was associated with conversion rates.
MIS procedures comprise approximately 13.5 % of surgical procedures for pancreatic tumors. In addition to tumor histology, differences in surgical approach were identified with respect to ethnicity for patients with tumors in the body/tail of the pancreas.
对于胰腺肿瘤患者，已发现多种差异会影响其获得医疗服务的机会，包括手术治疗，进而对长期肿瘤学结局产生不利影响。本研究的目的是调查不同人口统计学特征的胰腺肿瘤患者在微创手术（MIS）方面的全国性差异。
我们利用美国外科医师学会（ACS）国家癌症数据库（NCDB），确定2010年至2011年期间接受开放手术或微创手术的胰腺肿瘤患者。进行多变量分析以研究与手术方式及转为开放手术相关的患者特征差异。
共识别出2809例患者。初始手术方式包括86.5%的开放手术（2430例）和13.5%的微创手术（87.6%为腹腔镜手术，12.4%为机器人手术）。肿瘤组织学与微创手术显著相关，神经内分泌肿瘤患者接受微创手术的可能性是腺癌患者的两倍多。胰腺内肿瘤位置也与微创手术相关，胰尾肿瘤通过微创手术切除的可能性是胰头肿瘤的三倍。对于胰腺体部或尾部疾病患者，种族与微创手术独立相关，西班牙裔患者接受微创手术的可能性较小。转为开放手术的比例为27.7%，地理位置与转换率相关。
微创手术约占胰腺肿瘤手术的13.5%。除肿瘤组织学外，对于胰腺体部/尾部肿瘤患者，手术方式在种族方面存在差异。
