Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Surg Endosc. 2021 Dec;35(12):6949-6959. doi: 10.1007/s00464-020-08206-y. Epub 2021 Jan 4.
A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC.
An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval.
Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP.
The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
在患有胰腺导管腺癌（PDAC）的患者中进行激进的左胰切除术可能需要进行广泛的多脏器切除术。由于缺乏比较研究，腹腔镜方法在广泛的左胰切除术（ERLP）中的作用尚不清楚。本研究的目的是比较腹腔镜与开放 ERLP 治疗 PDAC 患者的结果。
进行了一项国际多中心倾向评分匹配研究，包括接受腹腔镜或开放 ERLP（L-ERLP；O-ERLP）治疗 PDAC 的患者（2007-2015 年）。使用 ISGPS 对扩展切除的定义。主要结果是总生存率、阴性切缘率（R0）和淋巴结检出率。
在 2007 年至 2015 年间，34 个中心的 12 个国家的 320 名患者接受了 ERLP（65 例 L-ERLP 与 255 例 O-ERLP）。经过倾向评分匹配后，44 例 L-ERLP 可以与 44 例 O-ERLP 匹配。在匹配队列中，L-ERLP 组的转化率为 35%。L-ERLP 的 R0 切除率（匹配队列）与 O-ERLP 相当（67%比 48%；P=0.063），但 L-ERLP 的淋巴结检出率低于 O-ERLP（中位数 11 比 19，P=0.023）。与 O-ERLP 相比，L-ERLP 术后胃排空延迟（0%比 16%，P=0.006）和住院时间更短（中位数 9 比 13 天，P=0.005）。对于其他器官切除术、除脾血管以外的血管切除术、Clavien-Dindo 分级≥III 级并发症或 90 天死亡率，结果相似（2%比 2%，P=0.973）。两组的中位总生存率相当（19 比 20 个月，P=0.571）。在 L-ERLP 中，转换并不会使预后恶化。
在需要对 PDAC 进行广泛胰切除术的患者中，腹腔镜方法可能是安全的，因为与 O-ERLP 相比，发病率、死亡率和总生存率似乎相似。与 O-ERLP 相比，L-ERLP 与高转化率和降低的淋巴结检出率相关，但也与胃排空延迟减少和住院时间缩短相关。
