Meng Ling-Wei, Cai Yun-Qiang, Li Yong-Bin, Cai He, Peng Bing
Department of Pancreatic Surgery, West China Hospital of Sichuan University.
Department of General Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China.
Surg Laparosc Endosc Percutan Tech. 2018 Feb;28(1):56-61. doi: 10.1097/SLE.0000000000000504.
Laparoscopic pancreaticoduodenectomy (LPD), a surgical option for nonpancreatic periampullary adenocarcinoma (NPPA), is a complex procedure that has become increasing popular. However, there is no consensus as to whether this technique should be performed routinely. Our aim was to evaluate the outcomes of LPD compared with open pancreaticoduodenectomy (OPD).
From October 2010 to September 2015, 58 LPDs were performed to treat NPPA and were compared with 58 OPDs, which can theoretically be carried out by laparoscopic approach. Patients were also matched based on their demographic data and pathologic diagnosis. Demographic information, intraoperative and postoperative data, pathologic data, and follow-up evaluation data were collected at our center.
All patients had a median follow-up of 34 months (range, 8 to 60 mo). Overall median survival during the study between the groups was not different (P=0.760). No significant differences between the 2 groups were found in terms of patient demographics, short-term complications, pathologic outcomes, or tumor-node-metastasis stage. With regard to operative time, the LPD group was slightly longer than the OPD group (P<0.001). There were significant differences between groups in the time to the first passage of flatus and the time to oral intake (P<0.001). However, no differences were seen in blood loss, length of intensive care unit stay, node positive, or R0 resection between the laparoscopic and open groups.
This study found that LPD is a feasible, safe, and effective method for the treatment of NPPA compared with OPD and may be a preferred method for surgeons to choose.
腹腔镜胰十二指肠切除术（LPD）是治疗非胰腺壶腹周围腺癌（NPPA）的一种手术选择，是一项复杂的手术，且越来越受欢迎。然而，对于该技术是否应常规开展尚无共识。我们的目的是评估LPD与开放胰十二指肠切除术（OPD）相比的疗效。
2010年10月至2015年9月，对58例接受LPD治疗的NPPA患者进行研究，并与58例理论上可通过腹腔镜手术完成的OPD患者进行比较。患者还根据人口统计学数据和病理诊断进行匹配。在我们中心收集了人口统计学信息、术中和术后数据、病理数据以及随访评估数据。
所有患者的中位随访时间为34个月（范围8至60个月）。研究期间两组的总体中位生存期无差异（P = 0.760）。两组在患者人口统计学、短期并发症、病理结果或肿瘤-淋巴结-转移分期方面均未发现显著差异。在手术时间方面，LPD组略长于OPD组（P < 0.001）。两组在首次排气时间和开始经口进食时间方面存在显著差异（P < 0.001）。然而，腹腔镜组和开放组在失血量、重症监护病房住院时间、淋巴结阳性或R0切除方面未发现差异。
本研究发现，与OPD相比，LPD是治疗NPPA的一种可行、安全且有效的方法，可能是外科医生首选的方法。
