Buanes Trond, Edwin Bjørn
Department of Gastroenterological Surgery, Division of Cancer, Surgery and Transplantation, Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo N-0424, Norway.
the Intervention Centre and Department of Hepato-Pancreatico-Biliary Surgery, Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo N-0424, Norway.
World J Gastrointest Endosc. 2018 Dec 16;10(12):383-391. doi: 10.4253/wjge.v10.i12.383.
The laparoscopic technique in distal pancreatic resection (LDP) has been widely accepted, and outcome data support the hypothesis that survival is improved, partly due to improved postoperative safety and recovery, thus optimizing treatment with adjuvant chemotherapy. But laparoscopic pancreaticoduodenectomy (LPD or Whipple-procedures) has spread more slowly, due to the complexity of the procedure. Surgical safety has been a problem in hospitals with low patient volume, resulting in raised postoperative mortality, requiring careful monitoring of outcome during the surgical learning curve. Robotic assistance is expected to improve surgical safety, but data on long term oncological outcome of laparoscopic Whipple procedures with or without robotic assistance is scarce. Future research should still focus surgical safety, but most importantly long term outcome, recorded as recurrence at maximal follow up or - at best - overall long term survival (OS). Available data show median survival above 2.5 years, five year OS more than 30% after LDP even in series with suboptimal adjuvant chemotherapy. Also after LPD, long term survival is reported equal to or longer than open resection. However, surgical safety during the learning curve of LPD is a problem, which hopefully can be facilitated by robotic assistance. Patient reported outcome should also be an endpoint in future trials, including patients with pancreatic ductal adenocarcinoma.
腹腔镜技术在胰体尾切除术（LDP）中已被广泛接受，结果数据支持生存率提高这一假设，部分原因是术后安全性和恢复情况得到改善，从而优化了辅助化疗的治疗效果。但腹腔镜胰十二指肠切除术（LPD或惠普尔手术）的推广较为缓慢，原因在于该手术的复杂性。在患者数量较少的医院，手术安全性一直是个问题，导致术后死亡率上升，在手术学习曲线期间需要仔细监测结果。机器人辅助有望提高手术安全性，但关于有无机器人辅助的腹腔镜惠普尔手术的长期肿瘤学结果的数据却很稀少。未来的研究仍应聚焦于手术安全性，但最重要的是长期结果，记录为最大随访期的复发情况，或者——最好是——总体长期生存率（OS）。现有数据显示，即使在辅助化疗欠佳的系列研究中，LDP术后的中位生存期超过2.5年，五年总生存率超过30%。LPD术后的长期生存率也据报道与开放切除术相当或更长。然而，LPD学习曲线期间的手术安全性是个问题，有望通过机器人辅助得到改善。患者报告的结果也应成为未来试验的一个终点，包括胰腺导管腺癌患者。
