Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
Washington University School of Medicine, Saint Louis, MO, USA.
Surg Endosc. 2022 May;36(5):3100-3109. doi: 10.1007/s00464-021-08611-x. Epub 2021 Jul 7.
Little is known about what factors predict better outcomes for patients who undergo minimally invasive pancreaticoduodenectomy (MIPD) versus open pancreaticoduodenectomy (OPD). We hypothesized that patients with dilated pancreatic ducts have improved postoperative outcomes with MIPD compared to OPD.
All patients undergoing pancreaticoduodenectomy were prospectively followed over a time period of 47 months, and perioperative and pathologic covariates and outcomes were compared. Ideal outcome after PD was defined as follows: (1) no complications, (2) postoperative length of stay < 7 days, and (3) negative (R0) margins on pathology. Patients with dilated pancreatic ducts (≥ 3 mm) who underwent MIPD were 1:3 propensity score-matched to patients with dilated ducts who underwent OPD and outcomes compared. Likewise, patients with non-dilated pancreatic ducts (< 3 mm) who underwent MIPD were 1:3 propensity score-matched to patients with non-dilated ducts who underwent OPD and outcomes were compared.
371 patients underwent PD-74 (19.9%) MIPD and 297 (80.1%) underwent OPD. Overall, patients who underwent MIPD had significantly less intraoperative blood loss. After 1:3 propensity score matching, patients with dilated pancreatic ducts who underwent MIPD (n = 45) had significantly lower overall complication and 90-day readmission rates compared to matched OPD patients (n = 135) with dilated ducts. Patients with dilated duct who underwent MIPD were more likely to have an ideal outcome than patients with OPD (29 vs 15%, p = 0.035). There were no significant differences in postoperative outcomes among propensity score-matched patients with non-dilated pancreatic ducts who underwent MIPD (n = 29) compared to matched patients undergoing OPD (n = 87) with non-dilated ducts.
MIPD is safe with comparable perioperative outcomes to OPD. Patients with pancreatic ducts ≥ 3 mm appear to derive the most benefit from MIPD in terms of fewer complications, lower readmission rates, and higher likelihood of ideal outcome.
对于接受微创胰十二指肠切除术（MIPD）与开放胰十二指肠切除术（OPD）的患者，哪些因素预测其预后更好，目前知之甚少。我们假设胰管扩张的患者行 MIPD 比 OPD 术后恢复更好。
所有接受胰十二指肠切除术的患者在 47 个月的时间内进行前瞻性随访，并比较围手术期和病理协变量及结果。PD 的理想结果定义如下：（1）无并发症；（2）术后住院时间<7 天；（3）病理切缘阴性（R0）。MIPD 治疗的胰管扩张（≥3mm）患者与 OPD 治疗的胰管扩张患者进行 1:3 倾向评分匹配，并比较其结果。同样，MIPD 治疗的非扩张胰管（<3mm）患者与 OPD 治疗的非扩张胰管患者进行 1:3 倾向评分匹配，并比较其结果。
371 例患者行 PD-74（19.9%）MIPD，297 例患者行 OPD。总体而言，MIPD 组患者术中出血量明显减少。经过 1:3 倾向评分匹配后，MIPD 治疗的胰管扩张患者（n=45）与胰管扩张的 OPD 患者（n=135）相比，总并发症和 90 天再入院率明显降低。与 OPD 患者相比，行 MIPD 的胰管扩张患者更有可能获得理想的结果（29%比 15%，p=0.035）。行 MIPD 的非扩张胰管患者（n=29）与行 OPD 的非扩张胰管患者（n=87）相比，其术后结局无显著差异。
MIPD 安全，与 OPD 的围手术期结局相当。胰管≥3mm 的患者从 MIPD 中获益最大，并发症更少，再入院率更低，获得理想结果的可能性更高。
