Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Academia Level 5, Singapore, 169856, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
World J Surg. 2020 Sep;44(9):3043-3051. doi: 10.1007/s00268-020-05582-3.
Pancreatic neuroendocrine neoplasms (PNENs) are increasingly prevalent with modern imaging, and surgical excision remains mainstay of treatment. This study aims to perform a propensity-score-matched (PSM) comparison of perioperative and oncologic outcomes following minimally invasive pancreatectomy (MIP) versus open pancreatectomy (OP) for PNEN.
A retrospective review was performed on patients who underwent curative-intent surgery for PNEN at Singapore General Hospital from 1997 to 2018. A 1:1 PSM was performed between MIP and OP, after which both groups were balanced for baseline variables.
We studied 134 patients who underwent surgery (36 MIP and 98 OP) for PNEN. Propensity-score-matched comparison between 35 MIP and 35 OP patients revealed that the MIP group had a longer operating time (MD = 75.0, 95% CI 15.2 to 134.8, P = 0.015), lower intraoperative blood loss (MD = - 400.0, 95% CI - 630.5 to - 169.5, P = 0.001), shorter median postoperative stay (MD = - 1.0, 95% CI - 1.9 to - 0.1, P = 0.029) and shorter median time to diet (MD = - 1.0, 95% CI - 1.9 to - 0.1, P = 0.039). There were no differences between both groups for short-term adverse outcomes and oncologic clearance. Overall survival (HR = 0.84, 95% CI 0.28 to 2.51, P = 0.761) and disease-free survival (HR = 0.57, 95% CI 0.20 to 1.64, P = 0.296) were comparable.
MIP is a safe and feasible approach for PNEN and is associated with a lower intraoperative blood loss, decreased postoperative stay and time to oral intake, at the expense of a longer operative time compared to OP.
随着现代影像学的发展，胰腺神经内分泌肿瘤（PNENs）的发病率越来越高，手术切除仍然是治疗的主要手段。本研究旨在对微创胰腺切除术（MIP）与开放胰腺切除术（OP）治疗 PNEN 的围手术期和肿瘤学结果进行倾向评分匹配（PSM）比较。
对 1997 年至 2018 年在新加坡综合医院接受根治性手术治疗的 PNEN 患者进行回顾性研究。对 MIP 和 OP 患者进行了 1:1 的 PSM，之后对两组的基线变量进行了平衡。
我们研究了 134 例接受手术（36 例 MIP 和 98 例 OP）治疗的 PNEN 患者。对 35 例 MIP 和 35 例 OP 患者进行的倾向评分匹配比较显示，MIP 组的手术时间较长（MD=75.0，95%CI 15.2 至 134.8，P=0.015），术中出血量较少（MD=-400.0，95%CI-630.5 至-169.5，P=0.001），术后中位住院时间较短（MD=-1.0，95%CI-1.9 至-0.1，P=0.029），术后中位饮食时间较短（MD=-1.0，95%CI-1.9 至-0.1，P=0.039）。两组的短期不良结果和肿瘤清除率无差异。总生存（HR=0.84，95%CI 0.28 至 2.51，P=0.761）和无病生存（HR=0.57，95%CI 0.20 至 1.64，P=0.296）相当。
MIP 是治疗 PNEN 的一种安全可行的方法，与 OP 相比，其术中出血量较少，术后住院时间和恢复经口进食时间较短，但手术时间较长。
