Kendrick Michael L, van Hilst Jony, Boggi Ugo, de Rooij Thijs, Walsh R Matthew, Zeh Herbert J, Hughes Steven J, Nakamura Yoshiharu, Vollmer Charles M, Kooby David A, Asbun Horacio J
Mayo Clinic, Rochester, MN, USA.
Academic Medical Center, Amsterdam, The Netherlands.
HPB (Oxford). 2017 Mar;19(3):215-224. doi: 10.1016/j.hpb.2017.01.023.
Minimally invasive pancreatoduodenectomy (MIPD) is increasingly performed with several institutional series and comparative studies reported. The aim was to conduct an assessment of the best-evidence and expert opinion on the current status and future challenges of MIPD.
A systematic review of the literature was performed and best-evidence presented at a State-of-the-Art conference on Minimally Invasive Pancreatic Resection. Expert panel discussion and audience response activity was used to assess perceived value and future direction.
From 582 studies, 26 comparative trials of MIPD and open pancreatoduodenectomy (OPD) were assessed for perioperative outcomes. There were no randomized controlled trials and all available comparative studies were determined of low quality. Several observational and case-matched studies demonstrate longer operative times, but less estimated blood loss and shorter length of hospital stay for MIPD. Registry-based studies demonstrate increased mortality rates after MIPD in low-volume centers. Oncologic assessment demonstrates comparable outcomes of MIPD. Expert opinion supports ongoing evaluation of MIPD.
MIPD appears to provide similar perioperative and oncologic outcomes in selected patients, when performed at experienced, high-volume centers. Its overall role in pancreatoduodenectomy needs to be better defined. Improved training opportunities, registry participation and prospective evaluation are needed.
随着多个机构系列研究和比较研究的报道，微创胰十二指肠切除术（MIPD）的开展越来越多。目的是对MIPD的现状和未来挑战进行最佳证据和专家意见评估。
对文献进行系统回顾，并在微创胰腺切除最新技术会议上展示最佳证据。通过专家小组讨论和观众反馈活动来评估感知价值和未来方向。
从582项研究中，评估了26项MIPD与开放胰十二指肠切除术（OPD）的比较试验的围手术期结果。没有随机对照试验，所有现有比较研究质量均较低。多项观察性研究和病例匹配研究表明，MIPD手术时间较长，但估计失血量较少，住院时间较短。基于登记处的研究表明，在低容量中心，MIPD术后死亡率增加。肿瘤学评估表明MIPD的结果相当。专家意见支持对MIPD进行持续评估。
在经验丰富的高容量中心进行MIPD时，在选定患者中似乎能提供相似的围手术期和肿瘤学结果。其在胰十二指肠切除术中的整体作用需要进一步明确。需要改善培训机会、参与登记处研究和进行前瞻性评估。
