微创与开放远端胰腺切除术治疗胰腺神经内分泌肿瘤：来自美国神经内分泌肿瘤研究组的分析

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group.

作者信息

Zhang Xu-Feng, Lopez-Aguiar Alexandra G, Poultsides George, Makris Eleftherios, Rocha Flavio, Kanji Zaheer, Weber Sharon, Fields Ryan, Krasnick Bradley A, Idrees Kamran, Smith Paula M, Cho Cliff, Schmidt Carl R, Maithel Shishir K, Pawlik Timothy M

机构信息

Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.

出版信息

J Surg Oncol. 2019 Aug;120(2):231-240. doi: 10.1002/jso.25481. Epub 2019 Apr 18.

DOI:10.1002/jso.25481

PMID:31001868

Abstract

BACKGROUND

To determine short- and long-term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for the treatment of pancreatic neuroendocrine tumor (pNET).

METHODS

The data of the patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were collected from a multi-institutional database. Propensity score matching (PSM) was used to generate 1:1 matched patients with MIDP and ODP.

RESULTS

A total of 576 patients undergoing curative DP for pNET were included. Two hundred and fourteen (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000-2004: 9.3% vs 2013-2016: 54.8%; P < 0.01). In the matched cohort (n = 141 in each group), patients who underwent MIDP had less blood loss (median, 100 vs 200 mL, P < 0.001), lower incidence of Clavien-Dindo ≥ III complications (12.1% vs 24.8%, P = 0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, P = 0.026). Patients who underwent MIDP had a lower incidence of recurrence (5-year cumulative recurrence, 10.1% vs 31.1%, P < 0.001), yet equivalent overall survival (OS) rate (5-year OS, 92.1% vs 90.9%, P = 0.550) compared with patients who underwent OPD.

CONCLUSION

Patients undergoing MIDP over ODP in the treatment of pNET had comparable oncologic surgical metrics, as well as similar long-term OS.

摘要

背景

比较微创远端胰腺切除术（MIDP）与开放远端胰腺切除术（ODP）治疗胰腺神经内分泌肿瘤（pNET）的短期和长期肿瘤学结局。

方法

收集2000年至2016年间因pNET接受根治性MIDP或ODP治疗的患者数据。采用倾向评分匹配（PSM）方法，将MIDP组和ODP组患者按1:1进行匹配。

结果

共有576例因pNET接受根治性远端胰腺切除术的患者纳入研究。其中，214例（37.2%）接受了MIDP，362例（62.8%）接受了ODP。随着时间推移，MIDP的实施例数逐渐增加（2000 - 2004年：9.3% vs 2013 - 2016年：54.8%；P < 0.01）。在匹配队列中（每组n = 141），接受MIDP的患者术中失血更少（中位数，100 vs 200 mL，P < 0.001），Clavien-Dindo≥III级并发症发生率更低（12.1% vs 24.8%，P = 0.026），住院时间更短（中位数，4天 vs 7天，P = 0.026）。与接受ODP的患者相比，接受MIDP的患者复发率更低（5年累积复发率，10.1% vs 31.1%，P < 0.001），但总生存率（OS）相当（5年OS，92.1% vs 90.9%，P = 0.550）。