Department of Surgery, University of Chicago, Chicago, IL.
Department of Surgery, Temple University, Philadelphia, PA.
Surgery. 2018 Mar;163(3):587-593. doi: 10.1016/j.surg.2017.12.001. Epub 2018 Feb 2.
Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes.
ACS-NSQIP 2014-2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed.
Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%) robotic or laparoscopic PD, 304 (24%) hybrid, and 197 (15%) unplanned conversions. There were no differences in demographics or comorbidities. Patients undergoing MIS-PD were less likely to have pancreatic ductal adenocarcinoma (30.9% vs 53.9%, P < 0.01) and less likely to have a dilated pancreatic duct (21.8% vs 46.7%, P < 0.01). 30-day morbidity was less for MIS-PD (63.6% vs 76.9%, P < 0.01), due to decreased delayed gastric emptying DGE) in the MIS-PD group (8.6% vs 15.5%, P < 0.01). 30-day mortality, length-of-stay, and readmissions were not significantly different. Patients undergoing MIS-PD had greater rates of CR-POPF (15.3% vs 13.0%, P = 0.03). On adjusted multivariable analysis, MIS-PD was not associated with CR-POPF (OR 1.05, 95% CI 0.87-1.26) but was associated with decreased DGE (OR 0.57, 95% CI 0.46-0.71).
MIS-PD has comparable short-term outcomes to open PD. While CR-POPF rates are greater for MIS-PD, this increased risk appears related to case-selection bias and not inherent to the MIS-approach.
评估微创胰十二指肠切除术（MIS-PD）与开放胰十二指肠切除术（OPD）疗效的研究受到选择偏倚和混合结果的限制。
使用 ACS-NSQIP 2014-2015 年胰腺手术靶向数据识别接受 PD 的患者。进行意向治疗分析。
在 7907 例 PD 患者中，有 1277 例（16%）接受了 MIS-PD：776 例（61%）机器人或腹腔镜 PD、304 例（24%）杂交手术、197 例（15%）未计划的转换。两组患者的人口统计学特征或合并症无差异。接受 MIS-PD 的患者患有胰腺导管腺癌的比例较低（30.9%比 53.9%，P<0.01），胰管扩张的比例也较低（21.8%比 46.7%，P<0.01）。MIS-PD 的 30 天发病率较低（63.6%比 76.9%，P<0.01），这归因于 MIS-PD 组的延迟性胃排空（DGE）减少（8.6%比 15.5%，P<0.01）。30 天死亡率、住院时间和再入院率无显著差异。接受 MIS-PD 的患者发生严重的术后胰瘘（CR-POPF）的比例更高（15.3%比 13.0%，P=0.03）。在调整后的多变量分析中，MIS-PD 与 CR-POPF 无关（OR 1.05，95%CI 0.87-1.26），但与 DGE 减少有关（OR 0.57，95%CI 0.46-0.71）。
MIS-PD 与开放 PD 的短期结果相当。虽然 MIS-PD 的 CR-POPF 发生率更高，但这种增加的风险似乎与病例选择偏倚有关，而不是与 MIS 方法固有相关。
