Ma Ming-Jian, Cheng He, Chen Yu-Sheng, Yu Xian-Jun, Liu Chen
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Shanghai Pancreatic Cancer Institute, Shanghai 200032, China; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China.
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Shanghai Pancreatic Cancer Institute, Shanghai 200032, China; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China.
Hepatobiliary Pancreat Dis Int. 2023 Apr;22(2):147-153. doi: 10.1016/j.hbpd.2023.01.004. Epub 2023 Jan 18.
Open pancreaticoduodenectomy (OPD) with portal or superior mesenteric vein resection and reconstruction has been applied in pancreatic cancer patients with tumor infiltration or adherence. However, it is controversial whether laparoscopic pancreaticoduodenectomy (LPD) with major vascular resection and reconstruction is feasible. This study aimed to evaluate the safety and feasibility of LPD with major vascular resection compared with OPD with major vascular resection.
We reviewed data for all pancreatic cancer patients undergoing LPD or OPD with vascular resection at Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, between February 2018 and May 2022. We compared the preoperative, intraoperative, and postoperative clinicopathological data of the two groups to conduct a comprehensive evaluation of LPD with major vascular resection.
A total of 63 patients underwent pancreaticoduodenectomy (PD) with portal or superior mesenteric vein resection and reconstruction, including 25 LPDs and 38 OPDs. The LPD group had less intraoperative blood loss (200 vs. 400 mL, P < 0.001), lower proportion of intraoperative blood transfusion (16.0% vs. 39.5%, P = 0.047), longer operation time (390 vs. 334 min, P = 0.004) and shorter postoperative hospital stay (11 vs. 14 days, P = 0.005). There was no perioperative death in all patients. There was no significant difference in the incidence of total postoperative complications, grade B/C postoperative pancreatic fistula, delayed gastric emptying and abdominal infection between the two groups. No postpancreatectomy hemorrhage nor bile leakage occurred during perioperative period. There was no significant difference in R0 resection rate and number of lymph nodes harvested between the two groups. Patency of reconstructed vessels in the two groups were 96.0% and 92.1%, respectively (P = 0.927).
LPD with portal or superior mesenteric vein resection and reconstruction was safe, feasible and oncologically acceptable for selected patients with pancreatic cancer, and it can achieve similar or even better perioperative results compared to open approach.
门静脉或肠系膜上静脉切除重建的开放性胰十二指肠切除术（OPD）已应用于肿瘤浸润或粘连的胰腺癌患者。然而，腹腔镜胰十二指肠切除术（LPD）联合主要血管切除重建是否可行仍存在争议。本研究旨在评估LPD联合主要血管切除与OPD联合主要血管切除的安全性和可行性。
我们回顾了2018年2月至2022年5月在复旦大学附属肿瘤医院胰腺外科接受LPD或OPD联合血管切除的所有胰腺癌患者的数据。我们比较了两组患者术前、术中和术后的临床病理数据，以对LPD联合主要血管切除进行综合评估。
共有63例患者接受了门静脉或肠系膜上静脉切除重建的胰十二指肠切除术（PD），其中25例为LPD，38例为OPD。LPD组术中出血量较少（200 vs. 400 mL，P < 0.001），术中输血比例较低（16.0% vs. 39.5%，P = 0.047），手术时间较长（390 vs. 334 min，P = 0.004），术后住院时间较短（11 vs. 14天，P = 0.005）。所有患者均无围手术期死亡。两组术后总并发症发生率、B/C级术后胰瘘、胃排空延迟和腹腔感染发生率无显著差异。围手术期未发生胰十二指肠切除术后出血和胆漏。两组的R0切除率和淋巴结清扫数目无显著差异。两组重建血管的通畅率分别为96.0%和92.1%（P = 0.927）。
对于部分胰腺癌患者，门静脉或肠系膜上静脉切除重建的LPD是安全、可行且符合肿瘤学要求的，与开放手术相比，其围手术期结果相似甚至更好。
