Adams Alexandra M, Russell Dylan M, Carpenter Elizabeth L, Nelson Daniel W, Yheulon Christopher G, Vreeland Timothy J
Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
Tripler Army Medical Center, Honolulu, HI, USA.
Surg Endosc. 2023 Jan;37(1):617-623. doi: 10.1007/s00464-022-09363-y. Epub 2022 Jun 15.
Minimally invasive distal pancreatectomy (MIDP) is gaining popularity due to improved perioperative outcomes over open distal pancreatectomy (ODP). The purpose of this study is to compare outcomes of MIDP and ODP using patients within a nationwide cohort.
The American College of Surgeons' National Quality Improvement Program (2014-2018) was used to evaluate incidence of post-operative pancreatic fistula (POPF) as well as 30-day composite major morbidity for patients undergoing MIDP vs. ODP. Matching was performed with a Mahalanobis-distance model for demographic characteristics, preoperative risk factors, and benign versus malignant pathology. Outcomes were assessed via weighted multiple logistic regression.
A total of 3940 patients underwent distal pancreatectomy (1978 MIDP, 1962 ODP). After matching, 2985 patients were included (1978 MIDP, 1007 ODP). The rates of major morbidity (8.65% MIDP vs. 9.76% ODP, p = 0.37) were similar between groups. The MIDP group was found to have significantly decreased length of stay (5.6 vs. 7 days, p ≤ 0.001), but greater rates (12.54% MIDP vs. 9.35% ODP, p = 0.02) of post-operative fistula.
When matched for baseline patient characteristics, MIDP was associated with shorter length of hospitalization with similar rates of morbidity compared to ODP. However, MIDP was associated with significantly increased rates of POPF. Further studies are needed to investigate this difference in POPF rate, and determine how to optimize MIDP surgical technique to reduce this risk.
与开放性远端胰腺切除术（ODP）相比，微创远端胰腺切除术（MIDP）因围手术期结局改善而越来越受欢迎。本研究的目的是使用全国队列中的患者比较MIDP和ODP的结局。
美国外科医师学会国家质量改进计划（2014 - 2018年）用于评估接受MIDP与ODP的患者术后胰瘘（POPF）的发生率以及30天综合主要发病率。采用马氏距离模型对人口统计学特征、术前危险因素以及良性与恶性病理进行匹配。通过加权多元逻辑回归评估结局。
共有3940例患者接受了远端胰腺切除术（1978例MIDP，1962例ODP）。匹配后，纳入2985例患者（1978例MIDP，1007例ODP）。两组之间的主要发病率相似（MIDP为8.65%，ODP为9.76%，p = 0.37）。发现MIDP组的住院时间显著缩短（5.6天对7天，p≤0.001），但术后胰瘘发生率更高（MIDP为12.54%，ODP为9.35%，p = 0.02）。
在匹配基线患者特征时，与ODP相比，MIDP与住院时间缩短以及相似的发病率相关。然而，MIDP与POPF发生率显著增加相关。需要进一步研究来调查这种POPF发生率的差异，并确定如何优化MIDP手术技术以降低这种风险。
