Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Hepatobiliary Pancreat Sci. 2023 Jul;30(7):970-982. doi: 10.1002/jhbp.1317. Epub 2023 Mar 9.
BACKGROUND/PURPOSE: Laparoscopic pancreaticoduodenectomy (PD) with major vein resection is a challenging procedure. Herein, we evaluated the feasibility and safety of laparoscopic vein resection in pancreatic head cancer with portal vein/superior mesenteric vein (PV/SMV) invasion, and compared the survival rate following laparoscopic surgery with that following open surgery.
We retrospectively reviewed the electronic medical records of all patients with pancreatic head cancer who underwent surgery performed by a single surgeon from January 2015 to December 2017. Kaplan-Meier curves were plotted to compare the disease-free survival, while Cox-proportional hazard models were used to analyze prognostic factors for survival.
Among 76 patients, 63 underwent open PD and 13 underwent laparoscopic PD with PV/SMV resection. There was no significant difference in the rate of complications, including portal vein stenosis and portal vein thrombus, recurrence of tumors, or pathological outcomes after surgery between the groups. There was also no significant difference in disease-free survival (p = .803) between the two groups. Additionally, the surgical method was not an independent prognostic factor for disease-free survival.
Laparoscopic PD with major vein resection can be feasibly performed in select patients with abutment and focal narrowing of the PV/SMV in pancreatic head cancer.
背景/目的：腹腔镜胰十二指肠切除术（PD）联合大静脉切除是一项具有挑战性的手术。在此，我们评估了腹腔镜下切除侵犯门静脉/肠系膜上静脉（PV/SMV）的胰头癌大静脉的可行性和安全性，并比较了腹腔镜手术和开腹手术的生存率。
我们回顾性分析了 2015 年 1 月至 2017 年 12 月期间由同一位外科医生实施手术的所有胰头癌患者的电子病历。绘制 Kaplan-Meier 曲线比较无病生存率，使用 Cox 比例风险模型分析生存的预后因素。
在 76 例患者中，63 例行开腹 PD，13 例行腹腔镜 PD 联合 PV/SMV 切除。两组患者的并发症发生率（包括门静脉狭窄和门静脉血栓形成、肿瘤复发或术后病理结果）无显著差异。两组无病生存率也无显著差异（p=0.803）。此外，手术方法不是无病生存率的独立预后因素。
对于胰头癌 PV/SMV 受累且局限性狭窄的患者，腹腔镜 PD 联合大静脉切除是可行的。
