Department of Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Department of General Surgery, 5th Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Med Sci Monit. 2020 Apr 26;26:e924190. doi: 10.12659/MSM.924190.
BACKGROUND Laparoscopic pancreatoduodenectomy (LPD) is a complicated procedure accompanied with high morbidity. Hybrid LPD is usually used as an alternative/transitional approach. This study aimed to prove whether the hybrid procedure is a safe procedure during a surgeon's learning curve of LPD. MATERIAL AND METHODS There were 48 hybrid LPD patients and 62 TLPD patients selected from January 2016 to December 2018; their demographics, surgical outcomes, and oncological data were retrospectively collected. Patient follow-up for the study continued until February 2020. RESULTS Patient demographics and baseline parameters were well balanced between the 2 groups. Intraoperative conditions, overall operation time was shorter for TLPD compared to hybrid LPD (407.79 minutes versus 453.29 minutes, respectively; P=0.035) and blood loss was less in TLPD patients compared to hybrid LPD patients (100.00 mL versus 300.00 mL, respectively; P<0.001). There was no difference in transfusion rates between the 2 groups (hybrid LPD 16.7% versus TLPD 4.8%; P=0.084). Postoperative outcomes and intensive care unit (ICU) stay was longer in the hybrid LPD patient group (hybrid LPD 1-day versus TLPD 0-day, P=0.002) and postoperative hospital stay was similar between the 2 groups (P=0.503). Reoperation rates, in-hospital, 30-day mortality, and 90-day mortality rates were comparable between the 2 groups (P=0.276, 1.000, 1.000, 0.884, respectively). Surgical site infection, bile leak, Clavien-Dindo classification (CDC) ≥3, delayed gastric emptying, grade B/C postoperative pancreatic fistulae, and grade B/C post pancreatectomy hemorrhage were not different between the 2 groups (P=0.526, 0.463, 0.220, 0.089, 0.165, 0.757, respectively). The tumor size, margin status, lymph nodes harvested, and metastasis were similar in the 2 groups (P=0.767, 0.438, 0.414, 0.424, respectively). In addition, the median overall survival rates were comparable between the 2 groups (hybrid LPD 29.0 months versus TLPD 30.0 months, P=0.996) as were the progression-free survival rates (hybrid LPD 11.0 months versus TLPD 12.0 months, P=0.373) CONCLUSIONS Hybrid LPD was comparable to TLPD. Hybrid LPD could be performed safely when some surgeons first started LPD (during the operative learning curve), while for skilled surgeons, TLPD could be applied initially.
腹腔镜胰十二指肠切除术（LPD）是一种复杂的手术，其发病率较高。杂交 LPD 通常作为一种替代/过渡方法。本研究旨在证明在外科医生的 LPD 学习曲线期间，杂交手术是否是一种安全的手术。
从 2016 年 1 月至 2018 年 12 月，选择了 48 例杂交 LPD 患者和 62 例 TLPD 患者，回顾性收集了他们的人口统计学、手术结果和肿瘤学数据。该研究的患者随访持续到 2020 年 2 月。
两组患者的人口统计学和基线参数均均衡。TLPD 的术中情况和总手术时间明显短于杂交 LPD（分别为 407.79 分钟和 453.29 分钟；P=0.035），TLPD 患者的出血量也明显少于杂交 LPD 患者（分别为 100.00 毫升和 300.00 毫升；P<0.001）。两组患者的输血率无差异（杂交 LPD 为 16.7%，TLPD 为 4.8%；P=0.084）。杂交 LPD 患者组的术后结果和 ICU 停留时间较长（杂交 LPD 为 1 天，TLPD 为 0 天；P=0.002），两组的术后住院时间相似（P=0.503）。两组的再手术率、住院期间死亡率、30 天死亡率和 90 天死亡率相似（P=0.276、1.000、1.000、0.884）。两组的手术部位感染、胆漏、Clavien-Dindo 分级（CDC）≥3、胃排空延迟、术后胰腺瘘分级 B/C、术后胰周出血分级 B/C 等无差异（P=0.526、0.463、0.220、0.089、0.165、0.757）。两组的肿瘤大小、切缘状态、淋巴结清扫、转移情况相似（P=0.767、0.438、0.414、0.424）。此外，两组的中位总生存时间相似（杂交 LPD 29.0 个月，TLPD 30.0 个月；P=0.996），无进展生存时间也相似（杂交 LPD 11.0 个月，TLPD 12.0 个月；P=0.373）。
杂交 LPD 与 TLPD 相当。当一些外科医生刚开始进行 LPD（在手术学习曲线期间）时，杂交 LPD 可以安全进行，而对于熟练的外科医生，可以最初应用 TLPD。
