腹腔镜与开腹胰十二指肠切除术治疗壶腹周围癌的长期疗效相似：一项病例匹配的对比研究。
The long-term outcomes of laparoscopic versus open pancreatoduodenectomy for ampullary carcinoma showed similar survival: a case-matched comparative study.
机构信息
Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan.
出版信息
Surg Endosc. 2022 Jul;36(7):4732-4740. doi: 10.1007/s00464-021-08813-3. Epub 2021 Nov 1.
BACKGROUND
Few studies have compared the oncological benefit of laparoscopic (LPD) and open pancreatoduodenectomy (OPD) for ampullary carcinoma. The aim of this study was to compare the oncological results of these two approaches.
METHODS
Between 2011 and 2020, 103 patients who underwent PD for ampullary carcinoma, including 31 LPD and 72 OPD, were retrospectively analyzed. Patients were matched on a 1:2 basis for age, sex, body mass index, American Society of Anaesthesiologists score, and preoperative biliary drainage. Short- and long-term outcomes of LPD and OPD were compared.
RESULTS
The 31 LPD were matched (1:2) to 62 OPD. LPD was associated with a shorter operative time (298 vs. 341 min, p = 0.02) than OPD and similar blood loss (361 vs. 341 mL, p = 0.747), but with more intra- and post-operative transfusions (29 vs. 8%, p = 0.008). There was no significant difference in postoperative mortality (6 vs. 2%), grades B/C postoperative pancreatic fistula (22 vs. 21%), delayed gastric emptying (23 vs. 35%), bleeding (22 vs. 11%), Clavien ≥ III morbidity (22 vs. 19%), or the length of hospital stay (26 vs. 21 days) between LPD and OPD, respectively, but there were more reinterventions (22 vs. 5%, p = 0.009). Pathological characteristics were similar for tumor size (21 vs. 22 mm), well differentiated tumors (41 vs. 38%), the number of harvested (23 vs. 26) or invaded lymph nodes (48 vs. 52%), R0 resection (84 vs. 90%), and other subtypes (T1/2, T3/4, phenotype). With a comparable mean follow-up (41 vs. 37 months, p = 0.59), there was no difference in 1-, 3-, and 5-year overall (p = 0.725) or recurrence-free survival (p = 0.155) which were (93, 74, 67% vs. 97, 79, 76%) and (85, 58, 58% vs. 90, 73, 73%), respectively.
CONCLUSION
This study showed a similar long-term oncological results between LPD and OPD for ampullary carcinoma. However, the higher morbidity observed with LPD compared to OPD, restricting its use to experienced centers.
背景
很少有研究比较腹腔镜（LPD）和开腹胰十二指肠切除术（OPD）治疗壶腹癌的肿瘤学获益。本研究旨在比较这两种方法的肿瘤学结果。
方法
2011 年至 2020 年，共 103 例壶腹癌患者接受 PD 治疗，其中 31 例行 LPD，72 例行 OPD。根据年龄、性别、体重指数、美国麻醉医师协会评分和术前胆道引流情况，将患者按 1:2 进行匹配。比较 LPD 和 OPD 的短期和长期结局。
结果
31 例 LPD 与 62 例 OPD 进行匹配（1:2）。与 OPD 相比，LPD 手术时间更短（298 分钟 vs. 341 分钟，p=0.02），出血量相似（361 毫升 vs. 341 毫升，p=0.747），但术中术后输血更多（29% vs. 8%，p=0.008）。两组术后死亡率（6% vs. 2%）、术后 B/C 级胰瘘（22% vs. 21%）、胃排空延迟（23% vs. 35%）、出血（22% vs. 11%）、Clavien≥III 级发病率（22% vs. 19%）或住院时间（26 天 vs. 21 天）均无显著差异，但再手术率（22% vs. 5%，p=0.009）更高。肿瘤大小（21 毫米 vs. 22 毫米）、高分化肿瘤（41% vs. 38%）、采集的淋巴结数量（23 个 vs. 26 个）或侵袭性淋巴结（48 个 vs. 52 个）、R0 切除（84% vs. 90%）和其他亚型（T1/2、T3/4、表型）的病理特征相似。在相似的平均随访（41 个月 vs. 37 个月，p=0.59）下，1 年、3 年和 5 年的总生存率（p=0.725）和无复发生存率（p=0.155）无差异（93%、74%、67% vs. 97%、79%、76%）和（85%、58%、58% vs. 90%、73%、73%）。
结论
本研究表明，腹腔镜和开腹胰十二指肠切除术治疗壶腹癌的长期肿瘤学结果相似。然而，与 OPD 相比，LPD 术后发病率更高，限制了其在经验丰富的中心的应用。
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