Al-Sadairi Abdul Rahman, Mimmo Antonio, Rhaiem Rami, Esposito Francesco, Rached Linda J, Tashkandi Ahmad, Zimmermann Perrine, Memeo Riccardo, Sommacale Daniele, Kianmanesh Reza, Piardi Tullio
Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, University of Champagne-Ardenne, Reims, France.
Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Ann Hepatobiliary Pancreat Surg. 2021 Feb 28;25(1):102-111. doi: 10.14701/ahbps.2021.25.1.102.
BACKGROUNDS/AIMS: Pancreaticoduodenectomy (PD) is the gold standard for the treatment of periampullary tumors. Many specialized centers have adopted the totally laparoscopic or hybrid laparoscopic PD (LPD). However, this procedure has not yet been standardized and serious debate is taking place towards its safety and feasibility. Herein, we report our recent experience whit hybrid-LPD.
During 2019 in our department 56 PD were performed and 21 (37.5%) underwent hybrid-LPD. We have retrospectively reviewed the short-term outcomes of these patients.
Main indication was pancreatic adenocarcinoma (71,4%). The median operative time and intraoperative blood loss were respectively 425 min (range, 226 to 576) and 317 ml (range 60 to 800 ml). Conversion to an open procedure was required in 4 patients (19%): 2 with suspected vein involvement, 1 for mesenteric panniculitis and 1 for biliary injury. The post-operative complication rate was 42.8% (9/21). Regarding post-operative pancreatic fistula, three patients (14.2%) had grade B and 1 grade C (4.7%). Median length of hospital stay was 14 days (range 9-23) and 90- days mortality was 4.7%. The mean number of harvested lymph nodes was 17.7 (range 12 to 26). The rate of margins R0 was 80%; R1 ＞0<1 mm was 10.5% and R1 0 mm was 9.5%.
Hydrid-LPD is safe and feasible. Careful patient selection and increasing experience can reduce the risk of post-operative complications.
背景/目的：胰十二指肠切除术（PD）是壶腹周围肿瘤治疗的金标准。许多专业中心已采用全腹腔镜或杂交腹腔镜胰十二指肠切除术（LPD）。然而，该手术尚未标准化，关于其安全性和可行性存在激烈争论。在此，我们报告我们近期杂交LPD的经验。
2019年我们科室共进行了56例PD手术，其中21例（37.5%）接受了杂交LPD。我们回顾性分析了这些患者的短期结局。
主要适应证为胰腺腺癌（71.4%）。中位手术时间和术中出血量分别为425分钟（范围226至576分钟）和317毫升（范围60至800毫升）。4例患者（19%）需要转为开放手术：2例怀疑有静脉受累，1例因肠系膜脂膜炎，1例因胆管损伤。术后并发症发生率为42.8%（9/21）。关于术后胰瘘，3例患者（14.2%）为B级，1例为C级（4.7%）。中位住院时间为14天（范围9至23天），90天死亡率为4.7%。平均清扫淋巴结数为17.7个（范围12至26个）。R0切缘率为80%；R1＞0＜1毫米为10.5%，R1 0毫米为9.5%。
杂交LPD是安全可行的。仔细的患者选择和经验积累可降低术后并发症风险。
