Won Yongjoon, Yoon Yoo-Seok, Han Ho-Seong, Cho Jai Young, Choi YoungRok, Hyun In Gun, Kim Kil Hwan
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Minim Invasive Surg. 2019 Mar;22(1):18-22. doi: 10.7602/jmis.2019.22.1.18. Epub 2019 Mar 15.
Laparoscopic distal pancreatectomy (LDP) has been widely performed for solid pseudopapillary neoplasm (SPN) involving the body or tail of the pancreas. However, it has not been established whether spleen preservation in LDP is oncologically safe for the treatment of SPN with malignant potential. In this study, we compared the short- and long-term outcomes between patients with SPN who underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) vs laparoscopic distal pancreatectomy with splenectomy (LDPS).
We retrospectively reviewed the medical records of 46 patients with SPN who underwent LDP between January 2005 and November 2016. Patients were divided into 2 groups according to spleen preservation: the LSPDP group (n=32) and the LDPS group (n=14). Clinicopathologic characteristics and perioperative outcomes were compared between groups.
There were no significant differences in pathologic variables, including tumor size, tumor location, node status, angiolymphatic invasion, or perineural invasion between groups. Median operating time was significantly longer in the LSPDP group vs the LDPS group (243 vs 172 minutes; =0.006). Estimated intraoperative blood loss was also significantly greater in the LSPDP group (310 vs 167 ml; =0.063). There were no significant differences in incidence of postoperative complications (≥ Clavien-Dindo class IIIa) or pancreatic fistula between groups. After a median follow-up of 35 months (range, 3~153 months), there was no recurrence or disease-specific mortality in either group.
The results show that LSPDP is an oncologically safe procedure for SPN involving the body or tail of the pancreas.
腹腔镜远端胰腺切除术（LDP）已广泛应用于治疗累及胰体或胰尾的实性假乳头状肿瘤（SPN）。然而，LDP中保留脾脏对于治疗具有恶性潜能的SPN在肿瘤学上是否安全尚未明确。在本研究中，我们比较了接受腹腔镜保留脾脏远端胰腺切除术（LSPDP）与腹腔镜远端胰腺切除联合脾切除术（LDPS）的SPN患者的短期和长期结局。
我们回顾性分析了2005年1月至2016年11月期间接受LDP的46例SPN患者的病历。根据是否保留脾脏将患者分为两组：LSPDP组（n = 32）和LDPS组（n = 14）。比较两组的临床病理特征和围手术期结局。
两组之间的病理变量，包括肿瘤大小、肿瘤位置、淋巴结状态、血管淋巴管侵犯或神经周围侵犯，均无显著差异。LSPDP组的中位手术时间显著长于LDPS组（243分钟对172分钟；P = 0.006）。LSPDP组的估计术中失血量也显著更多（310毫升对167毫升；P = 0.063）。两组之间术后并发症（≥Clavien-Dindo IIIa级）或胰瘘的发生率无显著差异。中位随访35个月（范围3~153个月）后，两组均无复发或疾病特异性死亡。
结果表明，LSPDP对于累及胰体或胰尾的SPN是一种肿瘤学上安全的手术方法。
