腹腔镜与开腹胰十二指肠切除术治疗胰腺神经内分泌肿瘤：单中心经验。
Laparoscopic versus open pancreaticoduodenectomy for pancreatic neuroendocrine tumors: a single-center experience.
机构信息
Department of Surgery, College of Medicine, Hallym University, Chuncheon, South Korea.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
出版信息
Surg Endosc. 2019 Dec;33(12):4177-4185. doi: 10.1007/s00464-019-06969-7. Epub 2019 Jul 12.
BACKGROUND
The efficacy and outcomes of laparoscopic resection for pancreatic neuroendocrine tumors (PNETs) are well established; however, specific data regarding the outcomes of laparoscopic pancreaticoduodenectomy (L-PD) are limited. The purpose of the present study was to compare the clinical and oncological outcomes following L-PD versus open PD (O-PD) in patients with PNETs.
METHODS
This retrospective study included 149 patients with PNETs who underwent PD at the Asan Medical Center between January 2006 and December 2017. In 58 patients, a laparoscopic approach was used (L-PD group), and in 91, an open technique was used (O-PD group).
RESULTS
The mean operative time was longer in the L-PD group than in the O-PD group (417.4 min vs. 362.2 min; p = 0.002), and the mean duration of postoperative stay was shorter in the L-PD group (12.6 days vs. 17.8 days; p < 0.001). The estimated blood loss (433.2 ml vs. 415.0 ml; p = 0.824) and the overall complication rate (34.5% vs. 38.5%; p = 0.624) did not significantly differ between the two groups. Regarding the oncological outcomes, there were no significant differences in the resection margins, tumor size, tumor grading, or T/N stage. The number of harvested lymph nodes in the L-PD group was lower than that in the O-PD group (7.1 vs. 10.8; p = 0.002). The 3-year overall survival rate was 91.9% in the L-PD group and 93.6% in the O-PD group (p = 0.974). The 3-year disease-free survival rate was 94.8% in the L-PD group and 86.7% in the O-PD group (p = 0.225).
CONCLUSIONS
L-PD is feasible for the treatment of PNETs in selected patients and has the advantages of short recovery time and reduced hospital stay. The survival rate was similar in both groups; however, due to the difference in the harvested lymph nodes, a randomized trial should confirm the oncological safety of L-PD for PNETs.
背景
腹腔镜切除胰腺神经内分泌肿瘤（PNETs）的疗效和结果已得到充分证实；然而，关于腹腔镜胰十二指肠切除术（L-PD）结果的具体数据有限。本研究的目的是比较 L-PD 与开放胰十二指肠切除术（O-PD）治疗 PNET 患者的临床和肿瘤学结果。
方法
本回顾性研究纳入了 2006 年 1 月至 2017 年 12 月期间在 Asan 医疗中心接受 PD 的 149 例 PNET 患者。其中 58 例采用腹腔镜方法（L-PD 组），91 例采用开放技术（O-PD 组）。
结果
L-PD 组的手术时间长于 O-PD 组（417.4 分钟 vs. 362.2 分钟；p=0.002），L-PD 组的术后住院时间短于 O-PD 组（12.6 天 vs. 17.8 天；p<0.001）。两组的估计出血量（433.2ml vs. 415.0ml；p=0.824）和总并发症发生率（34.5% vs. 38.5%；p=0.624）无显著差异。在肿瘤学结果方面，两组的切缘、肿瘤大小、肿瘤分级或 T/N 分期无显著差异。L-PD 组的淋巴结采集数量少于 O-PD 组（7.1 个 vs. 10.8 个；p=0.002）。L-PD 组的 3 年总生存率为 91.9%，O-PD 组为 93.6%（p=0.974）。L-PD 组的 3 年无病生存率为 94.8%，O-PD 组为 86.7%（p=0.225）。
结论
在选择的患者中，L-PD 治疗 PNET 是可行的，具有恢复时间短和住院时间短的优点。两组的生存率相似；然而，由于淋巴结采集的差异，应进行随机试验以确认 L-PD 治疗 PNET 的肿瘤学安全性。
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