Paracha Munizay, Van Orden Kathryn, Patts Gregory, Tseng Jennifer, McAneny David, Sachs Teviah
Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
Boston University School of Public Health, Boston, MA, USA.
World J Surg. 2019 Mar;43(3):937-943. doi: 10.1007/s00268-018-4855-8.
Routine preoperative staging in pancreas cancer is controversial. We sought to evaluate the rates of diagnostic laparoscopy (DLAP) for pancreatic cancer.
We queried the National Surgical Quality Improvement Program for patients with pancreas cancer (2005-2013) and compared groups who underwent DLAP, exploratory laparotomy (XLAP), pancreas resection (RSXN) or therapeutic bypass (THBP). We compared demographics, comorbidities, postoperative complications, 30-day mortality (Chi-square P < 0.05) and trends over time (R 0-1).
We identified 17,138 patients (RSXN 81.8%, XLAP 16.5%, THBP 8.2%, and DLAP 12.9%), with some having multiple CPT codes. Only 10.3% (n = 1432) of RSXN patients underwent DLAP prior to resection. XLAP occurred in 49.5% of non-RSXN patients, of whom 67.1% had no other operation. The percentage of patients undergoing RSXN increased 20.3% over time (R 0.81), while DLAP decreased 52.6% (R 0.92). XLAP patients without other operations decreased from 4.2 to 2.4%, although not linearly (R 0.31). Only 10.3% of XLAP had a diagnostic laparoscopy as well, leaving nearly 90% of these patients with an exploratory laparotomy without RSXN or THBP.
Diagnostic laparoscopy for pancreas malignancy is becoming less common but could benefit a subset of patients who undergo open exploration without resection or therapeutic bypass.
胰腺癌的常规术前分期存在争议。我们试图评估胰腺癌诊断性腹腔镜检查（DLAP）的发生率。
我们查询了国家外科质量改进计划中胰腺癌患者的数据（2005 - 2013年），并比较了接受DLAP、探查性剖腹术（XLAP）、胰腺切除术（RSXN）或治疗性旁路手术（THBP）的患者组。我们比较了人口统计学特征、合并症、术后并发症、30天死亡率（卡方检验P < 0.05）以及随时间的变化趋势（R 0 - 1）。
我们确定了17138例患者（RSXN占81.8%，XLAP占16.5%，THBP占8.2%，DLAP占12.9%），部分患者有多个CPT编码。只有10.3%（n = 1432）的RSXN患者在切除术前接受了DLAP。49.5%的非RSXN患者进行了XLAP，其中67.1%没有进行其他手术。接受RSXN的患者比例随时间增加了20.3%（R = 0.81），而DLAP下降了52.6%（R = 0.92）。未进行其他手术的XLAP患者比例从4.2%降至2.4%，但并非呈线性下降（R = 0.31）。只有10.3%的XLAP患者也进行了诊断性腹腔镜检查，这意味着近90%的这些患者进行了未行RSXN或THBP的探查性剖腹术。
胰腺癌的诊断性腹腔镜检查越来越不常见，但可能使一部分接受开放性探查但未行切除或治疗性旁路手术的患者受益。
