Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, Kortrijk, Belgium.
Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, Kortrijk, Belgium.
Int J Surg. 2019 Dec;72:137-143. doi: 10.1016/j.ijsu.2019.10.037. Epub 2019 Nov 5.
Laparoscopic pancreatic surgery still represents a challenge for surgeons. However, in recent decades the experience is expanding. Recent systematic reviews and meta-analyses confirm that laparoscopic pancreatic resection (LPR) is safe, feasible and worthwhile. This study analyses the first 100 consecutive LPRs in our centre.
A retrospective analysis was conducted of the first 100 LPRs in a single supra-regional Belgian centre, performed between January 2012 and January 2019. Pre-, peri- and postoperative data were retrieved from a prospectively maintained database. All procedures were performed laparoscopically by two attending surgeons, specialized in minimally invasive and hepatopancreatobiliary surgery.
Of 100 procedures, 62 laparoscopic pancreatoduodenectomies (LPD) and 36 laparoscopic distal pancreatectomies (LDP) were performed, along with 1 enucleation and 1 central pancreatectomy. Indication was malignancy in 70%. Conversion rate was 24,2% in LPD and 11% in LDP. Median operative time was 330 min (IQR 300-360) in LPD and 150 min (IQR 142.5-210) in LDP. Median blood loss was 200 mL (IQR 100-487.5) in LPD and 150 mL (IQR 50-500) in LDP, transfusion rate was 22.6% and 8.3% respectively. Median length of stay (LOS) was 13 days (IQR 10-19.25) in LPD and 9 days (IQR 9-14) in LDP. R0 resection rate was 88.6% (62/70). Major complication rate (Clavien-Dindo grade III-IV) was 12%. Thirty-day mortality was 0%, 90-day mortality was 2%.
Our results confirm that LPR is a feasible and safe alternative to open pancreatic surgery. Safe implementation with a clear strategy is fundamental to gain experience and overcome the learning curve of this technically demanding procedures.
腹腔镜胰腺手术仍然对外科医生来说是一项挑战。然而，近几十年来，这种手术的经验不断扩大。最近的系统评价和荟萃分析证实，腹腔镜胰腺切除术（LPR）是安全、可行和值得的。本研究分析了我们中心的前 100 例连续腹腔镜胰腺切除术。
对 2012 年 1 月至 2019 年 1 月期间在比利时单一超区域中心进行的前 100 例腹腔镜胰腺切除术进行回顾性分析。从一个前瞻性维护的数据库中检索术前、术中和术后数据。所有手术均由两位专门从事微创和肝胆胰手术的主治外科医生进行腹腔镜操作。
在 100 例手术中，进行了 62 例腹腔镜胰十二指肠切除术（LPD）和 36 例腹腔镜胰体尾切除术（LDP），1 例胰腺肿瘤剜除术和 1 例胰腺中段切除术。70%的手术适应证为恶性肿瘤。LPD 的中转率为 24.2%，LDP 的中转率为 11%。LPD 的中位手术时间为 330 分钟（IQR 300-360），LDP 的中位手术时间为 150 分钟（IQR 142.5-210）。LPD 的中位出血量为 200 毫升（IQR 100-487.5），LDP 的中位出血量为 150 毫升（IQR 50-500），输血率分别为 22.6%和 8.3%。LPD 的中位住院时间（LOS）为 13 天（IQR 10-19.25），LDP 的中位 LOS 为 9 天（IQR 9-14）。R0 切除率为 88.6%（62/70）。主要并发症发生率（Clavien-Dindo 分级 III-IV）为 12%。30 天死亡率为 0%，90 天死亡率为 2%。
我们的结果证实，LPR 是一种安全可行的开放胰腺手术替代方法。安全实施并制定明确的策略对于获得经验和克服这一技术要求较高的手术的学习曲线至关重要。
