腹腔镜胰十二指肠切除术与开腹胰十二指肠切除术治疗胰导管腺癌：肿瘤学结果和长期生存。
Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic outcomes and long-term survival.
机构信息
Department of Gastroenterology & Pancreatic Surgery, Zhejiang Province People's Hospital, No 158 Shangtang Road, Hangzhou, 310000, Zhejiang, People's Republic of China.
Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, 310014, Zhejiang, People's Republic of China.
出版信息
Surg Endosc. 2020 May;34(5):1948-1958. doi: 10.1007/s00464-019-06968-8. Epub 2019 Jul 17.
OBJECTIVE
The study aimed to compare the oncologic outcomes and long-term survival of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for patients diagnosed with pancreatic ductal adenocarcinoma (PDAC).
BACKGROUND
Substantial evidence demonstrated that LPD is technically safe and feasible with perioperative outcomes equivalent to that of OPD. However, for patients with malignancy, especially PDAC, the oncologic outcomes and long-term survival of patients who underwent LPD remains to be elucidated.
METHODS
Studies on LPD for the treatment of PDAC published before December 25, 2018 were searched online. The oncologic outcomes (e.g., numbers of lymph nodes retrieved, negative margin (R0) resection), and long-term survival (postoperative survival from 1 to 5 year) of LPD were compared to that of ODP.
RESULTS
After screening 1507 studies, six comparative cohort studies, which reported the oncologic outcomes and long-term survival of patients with PDAC were included. No significant difference was found between LPD and OPD regarding lymph nodes harvested (OR 1.96, 95% CI - 1.17 to 5.09, p = 0.22), R0 rate (OR 1.44, 95% CI 1.00 to 2.06, p = 0.05), number of positive lymph nodes (OR - 0.44, 95% CI - 1.06 to 0.17, p = 0.16), rate of adjuvant treatment (OR 1.04, 95% CI 0.68 to 1.59, p = 0.86) and time to adjuvant treatment (OR - 6.21, 95% CI - 16.00 to 3.59, p = 0.21). LPD showed similar 1-year (OR 1.20, 95% CI 0.87 to 1.65, p = 0.28), and 2-year survival (OR 1.25, 95% CI 0.94 to 1.66, p = 0.13) to that of OPD. The 3-year (OR 1.50, 95% CI 1.12 to 2.02, p = 0.007), 4-year (OR 1.73, 95% CI 1.02 to 2.93, p = 0.04), and 5-year survival (OR 2.11, 95% CI 1.35 to 3.31, p = 0.001) were significantly longer in LPD group.
CONCLUSION
For the treatment of PDAC, the oncologic outcomes of LPD were equivalent to that of OPD; LPD seemed promising regarding the postoperative long-term survival.
目的
本研究旨在比较腹腔镜胰十二指肠切除术（LPD）和开腹胰十二指肠切除术（OPD）治疗胰腺导管腺癌（PDAC）患者的肿瘤学结果和长期生存情况。
背景
大量证据表明，LPD 在技术上是安全可行的，其围手术期结果与 OPD 相当。然而，对于恶性肿瘤患者，尤其是 PDAC 患者，LPD 的肿瘤学结果和长期生存情况仍有待阐明。
方法
在线搜索了截至 2018 年 12 月 25 日发表的关于 LPD 治疗 PDAC 的研究。比较了 LPD 和 OPD 的肿瘤学结果（如，淋巴结检出数、阴性切缘（R0）切除率）和长期生存（术后 1 至 5 年的生存情况）。
结果
经过筛选 1507 项研究，纳入了 6 项比较队列研究，报告了 PDAC 患者的肿瘤学结果和长期生存情况。LPD 与 OPD 之间在淋巴结检出数（OR 1.96，95%CI-1.17 至 5.09，p=0.22）、R0 切除率（OR 1.44，95%CI 1.00 至 2.06，p=0.05）、阳性淋巴结数（OR-0.44，95%CI-1.06 至 0.17，p=0.16）、辅助治疗率（OR 1.04，95%CI 0.68 至 1.59，p=0.86）和辅助治疗时间（OR-6.21，95%CI-16.00 至 3.59，p=0.21）方面均无显著差异。LPD 的 1 年（OR 1.20，95%CI 0.87 至 1.65，p=0.28）和 2 年生存率（OR 1.25，95%CI 0.94 至 1.66，p=0.13）与 OPD 相似。LPD 组的 3 年（OR 1.50，95%CI 1.12 至 2.02，p=0.007）、4 年（OR 1.73，95%CI 1.02 至 2.93，p=0.04）和 5 年生存率（OR 2.11，95%CI 1.35 至 3.31，p=0.001）显著更高。
结论
对于 PDAC 的治疗，LPD 的肿瘤学结果与 OPD 相当；LPD 在术后长期生存方面似乎更有前景。
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