Katsuki Ryusuke, Jo Taisuke, Yasunaga Hideo, Kumazawa Ryosuke, Uda Kazuaki
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan.
Surgery. 2021 Jun;169(6):1427-1433. doi: 10.1016/j.surg.2020.12.018. Epub 2021 Jan 22.
Whether laparoscopic pancreatoduodenectomy is a feasible treatment option equivalent to open pancreatoduodenectomy remains unclear. Using a nationwide inpatient database, we investigated the postoperative outcomes of laparoscopic pancreatoduodenectomy versus open pancreatoduodenectomy.
We conducted a retrospective cohort study using a nationwide inpatient database in Japan. We included patients who underwent pancreatoduodenectomy from April 2016 to March 2018. One-to-four propensity score matching was used to compare in-hospital mortality, postoperative complications, perioperative findings, and total hospitalization costs between the 2 groups. We also compared outcomes between laparoscopic pancreatoduodenectomy and open pancreatoduodenectomy in low- and high-volume hospitals.
We identified 2,100 eligible patients. The laparoscopic pancreatoduodenectomy group contained higher proportions of younger patients and patients with fewer comorbidities compared with the open pancreatoduodenectomy group. Using propensity score matching, 95 patients in the laparoscopic pancreatoduodenectomy group were matched with 380 patients in the open pancreatoduodenectomy group. No significant differences in in-hospital mortality or postoperative complication rates were found between the groups. Compared with the open pancreatoduodenectomy group, the laparoscopic pancreatoduodenectomy group showed a longer duration of anesthesia (639 vs 497 minutes; P < .001), higher proportion of unplanned mechanical ventilation (10% vs 3%; P = .007), and higher total hospitalization costs (32,242 vs 24,657 US dollars; P < .001). The subgroup analyses showed that laparoscopic pancreatoduodenectomy was associated with a higher proportion of unplanned mechanical ventilation than open pancreatoduodenectomy but only in low-volume hospitals.
This study demonstrated almost no advantage of laparoscopic pancreatoduodenectomy over open pancreatoduodenectomy. Our results suggest that laparoscopic pancreatoduodenectomy can be an alternative option for open pancreatoduodenectomy only in high-volume hospitals.
腹腔镜胰十二指肠切除术是否是等同于开放性胰十二指肠切除术的可行治疗选择仍不清楚。我们利用全国住院患者数据库，研究了腹腔镜胰十二指肠切除术与开放性胰十二指肠切除术的术后结局。
我们使用日本全国住院患者数据库进行了一项回顾性队列研究。纳入2016年4月至2018年3月期间接受胰十二指肠切除术的患者。采用1:4倾向评分匹配法比较两组患者的院内死亡率、术后并发症、围手术期情况及总住院费用。我们还比较了低手术量医院和高手术量医院中腹腔镜胰十二指肠切除术与开放性胰十二指肠切除术的结局。
我们确定了2100例符合条件的患者。与开放性胰十二指肠切除术组相比，腹腔镜胰十二指肠切除术组年轻患者和合并症较少的患者比例更高。采用倾向评分匹配法，腹腔镜胰十二指肠切除术组的95例患者与开放性胰十二指肠切除术组的380例患者进行了匹配。两组患者的院内死亡率或术后并发症发生率无显著差异。与开放性胰十二指肠切除术组相比，腹腔镜胰十二指肠切除术组的麻醉时间更长（639分钟对497分钟；P <.001），非计划机械通气比例更高（10%对3%；P =.007），总住院费用更高（32242美元对24657美元；P <.001）。亚组分析显示，腹腔镜胰十二指肠切除术与非计划机械通气比例高于开放性胰十二指肠切除术相关，但仅在低手术量医院中如此。
本研究表明，腹腔镜胰十二指肠切除术相对于开放性胰十二指肠切除术几乎没有优势。我们的结果表明，腹腔镜胰十二指肠切除术仅在高手术量医院中可作为开放性胰十二指肠切除术的替代选择。
