Yang Dujiang, Li Mao, Li Zhenlu, Zhang Ling, Hu Weiming, Ke Nengwen, Xiong Junjie
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China.
Langenbecks Arch Surg. 2023 Jan 18;408(1):40. doi: 10.1007/s00423-023-02752-4.
Laparoscopic central pancreatectomy (LCP) has been implemented in pancreatic surgery; however, open surgery is still the predominant approach for central pancreatectomy (CP). Our objective was to compare LCP with open CP (OCP).
Data were collected from patients with tumours located in the pancreatic neck and proximal body who underwent CP in the Department of Pancreatic Surgery West China Hospital from January 1, 2010, to June 30, 2019. A comparison between the LCP and OCP groups was performed.
Fifteen patients underwent CP via the laparoscopic approach, and 96 patients underwent CP via the open approach. Using 1:2 propensity score matching (PSM), 12 patients in the LCP group were matched to 21 in the OCP group. Regarding safety, postoperative pancreatic fistula (POPF) was not significantly different between the two groups (13.3% vs. 12.5%, P = 1.000), even with PSM (16.7% vs. 14.3%, P = 1.000). However, regarding effectiveness, the operative time in the OCP group was significantly shorter than that in the LCP group before (307.0 ± 92.3 ml vs. 220.6 ± 63.6 ml, P < 0.000) and after (300.3 ± 90.2 ml vs. 212.7 ± 44.4 ml, P = 0.002) PSM. Regarding length of stay (LOS), there was no difference between the two groups before (13.1 ± 13.7 days vs. 12.7 ± 10.1 days, P = 0.376) and after PSM (14.4 ± 15.1 days vs. 14.5 ± 16.2 days, P = 0.985). The length of the resected pancreas was shorter in the OCP group than in the LCP group before PSM (50.0 ± 13.2 mm vs. 41.1 ± 11.1 mm, P = 0.043). However, there was no difference between the two groups after PSM (47.9 ± 12.5 mm vs. 37.9 ± 10.4 mm, P = 0.084). Moreover, the other variables showed no difference between the two groups before and after PSM.
LCP can demonstrate similar safety and effectiveness to OCP, even in the early stages of the learning curve.
腹腔镜胰体尾切除术（LCP）已应用于胰腺手术；然而，开放手术仍是胰体尾切除术（CP）的主要术式。我们的目的是比较LCP与开放胰体尾切除术（OCP）。
收集2010年1月1日至2019年6月30日在四川大学华西医院胰腺外科接受CP治疗的胰腺颈部和胰体近端肿瘤患者的数据。对LCP组和OCP组进行比较。
15例患者通过腹腔镜手术行CP，96例患者通过开放手术行CP。采用1:2倾向评分匹配（PSM），LCP组12例患者与OCP组21例患者匹配。在安全性方面，两组术后胰瘘（POPF）发生率无显著差异（13.3%对12.5%，P = 1.000），PSM后也是如此（16.7%对14.3%，P = 1.000）。然而，在有效性方面，OCP组术前（307.0±92.3分钟对220.6±63.6分钟，P < 0.000）和术后（300.3±90.2分钟对212.7±44.4分钟，P = 0.002）的手术时间均显著短于LCP组。在住院时间（LOS）方面，两组术前（13.1±13.7天对12.7±10.1天，P = 0.376）和PSM后（14.4±15.1天对14.5±16.2天，P = 0.985）均无差异。PSM前，OCP组切除胰腺的长度短于LCP组（50.0±13.2毫米对41.1±11.1毫米，P = 0.043）。然而，PSM后两组无差异（47.9±12.5毫米对37.9±10.4毫米，P = 0.084）。此外，其他变量在PSM前后两组间均无差异。
即使在学习曲线的早期阶段，LCP在安全性和有效性方面也可与OCP相媲美。
