Stauffer John A, Coppola Alessandro, Villacreses Diego, Mody Kabir, Johnson Elizabeth, Li Zhuo, 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.
Surg Endosc. 2017 May;31(5):2233-2241. doi: 10.1007/s00464-016-5222-1. Epub 2016 Sep 7.
Pancreaticoduodenectomy remains as the only treatment that offers a chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas. In recent years, laparoscopic pancreaticoduodenectomy (LPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons. This study reviews and compares perioperative results and long-term survival of patients undergoing LPD versus OPD at a single institution over a 20-year time period.
From 1995 to 2014, 612 patients underwent PD and 251 patients were found to have PDAC. These latter patients were reviewed and divided into two groups: OPD (n = 193) and LPD (n = 58). LPD was introduced in November 2008 and performed simultaneous to OPD within the remaining time period. Ninety-day perioperative outcomes and long-term survival were analyzed.
Patient demographics were well matched. Operative time was significantly longer with LPD, but blood loss and transfusion rate were lower. Postoperative complications, intensive care unit stay, and overall hospital stay was similar. OPD was associated with larger tumor size; LPD was associated with greater lymph node harvest and lower lymph node ratio. LPD was performed by hand-assist method in 3 (5.2 %) patients and converted to open in 14 (24.1 %). Neoadjuvant therapy was performed in 17 (8.8 %) patients for OPD and 4 (6.9 %) for LPD. The estimated median survival was 20.3 months for OPD and 18.5 months for LPD. Long-term survival was similar for 1-, 2-, 3-, 4-, and 5-year survival for OPD (68, 40, 24, 17 and 15 %) and for LPD (67, 43, 43, 38 and 32 %), respectively.
LPD provides similar short-term outcomes and long-term survival to OPD in the treatment of PDAC.
胰十二指肠切除术仍是唯一为胰头导管腺癌（PDAC）患者提供治愈机会的治疗方法。近年来，当由经验丰富的外科医生进行时，腹腔镜胰十二指肠切除术（LPD）已被引入作为开放性胰十二指肠切除术（OPD）的一种可行替代方法。本研究回顾并比较了在单一机构20年时间内接受LPD与OPD患者的围手术期结果和长期生存率。
1995年至2014年，612例患者接受了胰十二指肠切除术，其中251例患者被诊断为PDAC。对这些患者进行回顾并分为两组：OPD组（n = 193）和LPD组（n = 58）。LPD于2008年11月引入，并在剩余时间段内与OPD同时进行。分析了90天围手术期结果和长期生存率。
患者人口统计学特征匹配良好。LPD的手术时间明显更长，但失血量和输血率更低。术后并发症、重症监护病房停留时间和总体住院时间相似。OPD与更大的肿瘤大小相关；LPD与更多的淋巴结清扫和更低的淋巴结比率相关。3例（5.2%）患者采用手辅助方法进行LPD，14例（24.1%）转为开放手术。OPD组17例（8.8%）患者和LPD组4例（6.9%）患者接受了新辅助治疗。OPD组的估计中位生存期为20.3个月，LPD组为18.5个月。OPD组和LPD组1年、2年、3年、4年和5年生存率分别为68%、40%、24%、17%和15%以及67%、43%、43%、38%和32%，长期生存率相似。
在PDAC治疗中，LPD与OPD的短期结果和长期生存率相似。
