Joliat Gaëtan-Romain, Demartines Nicolas, Halkic Nermin, Petermann David, Schäfer Markus
Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
Ann Med Surg (Lond). 2016 Dec 5;13:1-5. doi: 10.1016/j.amsu.2016.12.001. eCollection 2017 Jan.
Laparoscopic distal pancreatectomy was introduced 15 years ago, but it is still not widely used. The aim of the study was to compare the postoperative complications and length of stay between open and laparoscopic distal pancreatectomy.
A search of our institutional pancreas database was performed. All consecutive distal pancreatectomy patients from 2000 to 2015 were identified. Demographics, peri- and postoperative outcomes were reviewed. Postoperative complications were graded using Clavien classification. Standard statistical analyses were performed.
One hundred and five patients underwent distal pancreatectomy (45 women, 60 men, median age of 63 years). Seventy-nine cases were performed open and 26 by laparoscopy (conversion rate from laparoscopy to laparotomy: 7/26). Characteristics of both groups were similar. The tumor proportion was similar in both groups (56/79 and 23/26, p = 0.114). Overall complication rate was 41/79 (52%) in the open group and 9/26 (36%) in the laparoscopy group (p = 0.175). Two patients died during hospital stay in the open group compared to 0 in the laparoscopy group (p = 1). The fistula rates were comparable (17/79 and 5/26, p = 1). Median length of stay was shorter for the laparoscopy group (8 12 days, p < 0.001), as well as the median intermediate care stay (1 3 days, p = 0.004).
Short-term outcomes after open and laparoscopic distal pancreatectomy regarding postoperative complications and mortality were similar, but length of stay was significantly shorter for the laparoscopic approach. Hence, laparoscopic distal pancreatectomy should be offered to all suitable patients.
腹腔镜远端胰腺切除术于15年前开始应用，但仍未得到广泛使用。本研究的目的是比较开放手术与腹腔镜远端胰腺切除术的术后并发症及住院时间。
检索我们机构的胰腺数据库。确定了2000年至2015年所有连续行远端胰腺切除术的患者。回顾了人口统计学、围手术期和术后结果。术后并发症采用Clavien分类法分级。进行了标准的统计分析。
105例患者接受了远端胰腺切除术（45例女性，60例男性，中位年龄63岁）。79例采用开放手术，26例采用腹腔镜手术（腹腔镜中转开腹率：7/26）。两组患者的特征相似。两组的肿瘤比例相似（56/79和23/26，p = 0.114）。开放手术组的总体并发症发生率为41/79（52%），腹腔镜手术组为9/26（36%）（p = 0.175）。开放手术组有2例患者在住院期间死亡，而腹腔镜手术组无死亡病例（p = 1）。瘘管发生率相当（17/79和5/26，p = 1）。腹腔镜手术组的中位住院时间较短（8 12天，p < 0.001），中位中级护理时间也较短（1 3天，p = 0.004）。
开放手术与腹腔镜远端胰腺切除术在术后并发症和死亡率方面的短期结果相似，但腹腔镜手术的住院时间明显较短。因此，应向所有合适的患者提供腹腔镜远端胰腺切除术。
