Tian Feng, Wang Yi-Zhi, Hua Su-Rong, Liu Qiao-Fei, Guo Jun-Chao
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.
BMC Surg. 2020 May 6;20(1):89. doi: 10.1186/s12893-020-00752-5.
The safety of total laparoscopic pancreaticoduodenectomy still remains controversial. Laparoscopic assisted pancreaticoduodenectomy (LAPD) may be an alternative selection. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon.
A comparison was conducted between LAPD and OPD from January 2013 to December 2018. Perioperative outcomes and short-term oncological results were compared. Univariate and multivariable analyses were performed to determine associations among variables.
133 patients were enrolled, 36 patients (27.1%) underwent LAPD and 97 (72.9%) underwent OPD. No 30-day and 90-day mortality occurred. LAPD was associated with decreased intraoperative estimated blood loss (300 versus 500 ml; P = 0.002), longer operative time (372 versus 305 min; P < 0.001) compared with OPD. LAPD had a conversion rate of 16.7%, and wasn't associated with an increased grade B/C pancreatic fistula rate, major surgical complications, intraoperative blood transfusion, reoperation rate or length of hospital stay after surgery. In the subset of 58 pancreatic ductal adenocarcinomas, R0 resection rate, median total harvested lymph node or lymph nodes ≥12 did not differ between the two groups.
LAPD could be performed with non-inferior short-term perioperative and oncologic outcomes achieved by OPD in selected patients.
全腹腔镜胰十二指肠切除术的安全性仍存在争议。腹腔镜辅助胰十二指肠切除术（LAPD）可能是一种替代选择。本研究的目的是比较同一外科医生连续进行的LAPD和开放胰十二指肠切除术（OPD）的队列。
对2013年1月至2018年12月期间的LAPD和OPD进行比较。比较围手术期结果和短期肿瘤学结果。进行单因素和多因素分析以确定变量之间的关联。
共纳入133例患者，36例（27.1%）接受LAPD，97例（72.9%）接受OPD。未发生30天和90天死亡率。与OPD相比，LAPD术中估计失血量减少（300对500 ml；P = 0.002），手术时间延长（372对305分钟；P < 0.001）。LAPD的转化率为16.7%，与B/C级胰瘘发生率增加、主要手术并发症、术中输血、再次手术率或术后住院时间无关。在58例胰腺导管腺癌亚组中，两组的R0切除率、中位总收获淋巴结数或≥12枚淋巴结数无差异。
在选定的患者中，LAPD可以实现与OPD相当的短期围手术期和肿瘤学结果。
