Huang Jing, Xiong Chaojie, Sheng Ye, Zhou Xinhua, Lu Cai-De, Cai Xiujun
Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
Gland Surg. 2021 Mar;10(3):1057-1066. doi: 10.21037/gs-21-56.
Laparoscopic distal pancreatosplenectomy is an effective and safe surgical modality for treating benign and borderline distal pancreatic tumors, but rarely for pancreatic cancer. This study aimed to compare the feasibility and safety of laparoscopic and open radical antegrade modular pancreatosplenectomy for pancreatic cancer.
Fifty-one patients with pancreatic cancer who underwent radical antegrade modular pancreatosplenectomy at Ningbo Medical Center Lihuili Hospital between January 2014 and July 2018 were enrolled. 20 patients underwent laparoscopic radical antegrade modular pancreatosplenectomy and 31 patients received open radical antegrade modular pancreatosplenectomy. Postoperative and short-term outcomes of the two groups of patients were analyzed.
The mean operation time, length of postoperative hospital stay, and overall postoperative morbidity were similar in the two groups (P>0.05). The laparoscopic radical antegrade modular pancreatosplenectomy group lost less blood (252.5±198.3 472.6±428.0 mL, P=0.037) and had lower transfusion rates (10.0% 35.4%, P=0.041) than the open radical antegrade modular pancreatosplenectomy group. The laparoscopic group also had statistically significantly earlier passing of first flatus (2.5±0.8 3.2±1.2 days, P=0.028) and first oral intake (2.9±1.0 3.7±1.6 days, P=0.042). Furthermore, the rates of postoperative pancreatic fistula (45.0% 32.3%) and overall complications (70.0% 74.2%) were not statistically difference between the two groups. The survival rates at 6 months, 1 year, and 2 years after surgery were not statistically difference between the laparoscopic and open groups (94.4% 93.5, 67.0% 78.0%, and 50.2% 38.3%, respectively).
The results of this study show that laparoscopic radical antegrade modular pancreatosplenectomy is feasible and safe for the treatment of pancreatic cancer.
腹腔镜远端胰腺脾切除术是治疗良性及交界性远端胰腺肿瘤的一种有效且安全的手术方式，但很少用于治疗胰腺癌。本研究旨在比较腹腔镜与开放根治性顺行模块化胰腺脾切除术治疗胰腺癌的可行性和安全性。
纳入2014年1月至2018年7月在宁波市医疗中心李惠利医院接受根治性顺行模块化胰腺脾切除术的51例胰腺癌患者。20例行腹腔镜根治性顺行模块化胰腺脾切除术，31例行开放根治性顺行模块化胰腺脾切除术。分析两组患者的术后及短期结局。
两组患者的平均手术时间、术后住院时间及总体术后发病率相似（P>0.05）。腹腔镜根治性顺行模块化胰腺脾切除术组的失血量（252.5±198.3对472.6±428.0 mL，P=0.037）和输血率（10.0%对35.4%，P=0.041）均低于开放根治性顺行模块化胰腺脾切除术组。腹腔镜组首次排气时间（2.5±0.8对3.2±1.2天，P=0.028）和首次经口进食时间（2.9±1.0对3.7±1.6天，P=0.042）在统计学上也显著更早。此外，两组术后胰瘘发生率（45.0%对32.3%）和总体并发症发生率（70.0%对74.2%）无统计学差异。腹腔镜组与开放组术后6个月、1年和2年的生存率无统计学差异（分别为94.4%对93.5%、67.0%对78.0%、50.2%对38.3%）。
本研究结果表明，腹腔镜根治性顺行模块化胰腺脾切除术治疗胰腺癌是可行且安全的。
