腹腔镜与开腹胰十二指肠切除术治疗胰导管腺癌：倾向评分匹配分析。
Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis.
机构信息
Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, P. R. China.
Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, P. R. China.
出版信息
Cancer Commun (Lond). 2019 Oct 28;39(1):66. doi: 10.1186/s40880-019-0410-8.
BACKGROUND
A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy (LPD) as an efficient and feasible surgical technique. However, few studies have investigated its applicability in pancreatic ductal adenocarcinoma (PDAC), and the long-term efficacy of LPD on PDAC remains unclear. This study aimed to compare the short- and long-term outcomes between LPD and open pancreaticoduodenectomy (OPD) for PDAC.
METHODS
The data of patients who had OPD or LPD for PDAC between January 2013 and September 2017 were retrieved. Their postoperative outcomes and survival were compared after propensity score matching.
RESULTS
A total of 309 patients were included. After a 2:1 matching, 93 cases in the OPD group and 55 in the LPD group were identified. Delayed gastric emptying (DGE), particularly grade B/C DGE, occurred less frequently in the LPD group than in the OPD group (1.8% vs. 36.6%, P < 0.001; 1.8% vs. 22.6%, P = 0.001). The overall complication rates were significantly lower in the LPD group than in the OPD group (49.1% vs. 71.0%, P = 0.008), whereas the rates of major complications were similar (10.9% vs. 14.0%, P = 0.590). In addition, the median overall survival was comparable between the two groups (20.0 vs. 18.7 months, P = 0.293).
CONCLUSION
LPD was found to be technically feasible with efficacy similar to OPD for patients with PDAC.
背景
越来越多的证据支持腹腔镜胰十二指肠切除术（LPD）作为一种有效且可行的手术技术。然而，很少有研究调查其在胰腺导管腺癌（PDAC）中的适用性，LPD 治疗 PDAC 的长期疗效仍不清楚。本研究旨在比较 LPD 和开腹胰十二指肠切除术（OPD）治疗 PDAC 的短期和长期疗效。
方法
回顾性分析 2013 年 1 月至 2017 年 9 月期间接受 OPD 或 LPD 治疗 PDAC 的患者数据。对倾向性评分匹配后的患者术后结局和生存情况进行比较。
结果
共纳入 309 例患者。经 2:1 匹配后，OPD 组 93 例，LPD 组 55 例。LPD 组的术后胃排空延迟（DGE），特别是 B/C 级 DGE 的发生率明显低于 OPD 组（1.8%比 36.6%，P<0.001；1.8%比 22.6%，P=0.001）。LPD 组的总并发症发生率明显低于 OPD 组（49.1%比 71.0%，P=0.008），但主要并发症发生率相似（10.9%比 14.0%，P=0.590）。此外，两组的总生存中位数无差异（20.0 个月比 18.7 个月，P=0.293）。
结论
对于 PDAC 患者，LPD 技术上可行，疗效与 OPD 相当。
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