Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University.
Translational Research Program, Osaka Medical and Pharmaceutical University.
Ann Surg. 2023 Oct 1;278(4):e805-e811. doi: 10.1097/SLA.0000000000005758. Epub 2022 Nov 18.
This study aimed to compare the short-term outcomes between laparoscopic and open distal pancreatectomy for lesions of the distal pancreas from a real-world database.
Reports on the benefits of laparoscopic distal pancreatectomy include 2 randomized controlled trials; however, large-scale, real-world data are scarce.
We analyzed the data of patients undergoing laparoscopic or open distal pancreatectomy for benign or malignant pancreatic tumors from April 2008 to May 2020 from a Japanese nationwide inpatient database. We performed propensity score analyses to compare the inhospital mortality, morbidity, readmission rate, reoperation rate, length of postoperative stay, and medical cost between the 2 groups.
From 5502 eligible patients, we created a pseudopopulation of patients undergoing laparoscopic and open distal pancreatectomy using inverse probability of treatment weighting. Laparoscopic distal pancreatectomy was associated with lower inhospital mortality during the period of admission (0.0% vs 0.7%, P <0.001) and within 30 days (0.0% vs 0.2%, P =0.001), incidence of reoperation during the period of admission (0.7% vs 1.7%, P =0.018), postpancreatectomy hemorrhage (0.4% vs 2.0%, P <0.001), ileus (1.1% vs 2.8%, P =0.007), and shorter postoperative length of stay (17 vs 20 d, P <0.001).
The propensity score analysis revealed that laparoscopic distal pancreatectomy was associated with better outcomes than open surgery in terms of inhospital mortality, reoperation rate, postoperative length of stay, and incidence of postoperative complications such as postpancreatectomy hemorrhage and ileus.
本研究旨在比较真实世界数据库中腹腔镜与开腹胰体尾切除术治疗胰体尾部病变的短期疗效。
腹腔镜胰体尾切除术的获益已有两项随机对照试验报道；然而，大规模的真实世界数据较为缺乏。
我们分析了 2008 年 4 月至 2020 年 5 月期间日本全国住院患者数据库中因良性或恶性胰腺肿瘤行腹腔镜或开腹胰体尾切除术患者的数据。我们通过倾向评分分析比较了两组患者的住院死亡率、发病率、再入院率、再次手术率、术后住院时间和医疗费用。
在 5502 例合格患者中，我们通过逆概率处理加权法创建了腹腔镜和开腹胰体尾切除术患者的伪人群。腹腔镜胰体尾切除术在住院期间（0.0%比 0.7%，P<0.001）和 30 天内（0.0%比 0.2%，P=0.001）的院内死亡率较低，住院期间再次手术的发生率（0.7%比 1.7%，P=0.018）、胰瘘（0.4%比 2.0%，P<0.001）、肠麻痹（1.1%比 2.8%，P=0.007）较低，术后住院时间较短（17 天比 20 天，P<0.001）。
倾向评分分析表明，腹腔镜胰体尾切除术与开腹手术相比，在住院死亡率、再次手术率、术后住院时间以及术后并发症（如胰瘘和肠麻痹）的发生率方面具有更好的疗效。
