Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, People's Republic of China.
Department of Pancreatic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
Surg Endosc. 2023 Jun;37(6):4381-4395. doi: 10.1007/s00464-023-09901-2. Epub 2023 Feb 9.
The results of laparoscopic pancreaticoduodenectomy combining with mesentericoportal vein resection and reconstruction (LPD-MPVRs) for pancreatic head adenocarcinoma are rarely reported. The aim of present study was to explore the short- and long-term outcomes of different type of LPD-MPVRs.
Patients who underwent LPD-MPVRs in 14 Chinese high-volume pancreatic centers between June 2014 and December 2020 were selected and compared.
In total, 142 patients were included and were divided into primary closure (n = 56), end-end anastomosis (n = 43), or interposition graft (n = 43). Median overall survival (OS) and median progress-free survival (PFS) between primary closure and end-end anastomosis had no difference (both P > 0.05). As compared to primary closure and end-end anastomosis, interposition graft had the worst median OS (12 months versus 19 months versus 17 months, P = 0.001) and the worst median PFS (6 months versus 15 months versus 12 months, P < 0.000). As compared to primary closure, interposition graft had almost double risk in major morbidity (16.3 percent versus 8.9 percent) and about triple risk (10 percent versus 3.6 percent) in 90-day mortality, while End-end anastomosis had only one fourth major morbidity (2.3 percent versus 8.9 percent). Multivariate analysis revealed postoperation hospital stay, American Society of Anesthesiologists (ASA) score, number of positive lymph nodes had negative impact on OS, while R0, R1 surgical margin had protective effect on OS. Postoperative hospital stay had negative impact on PFS, while primary closure, end-end anastomosis, short-term vascular patency, and short-term vascular stenosis positively related to PFS.
In LPD-MPVRs, interposition graft had the worst OS, the worst PFS, the highest rate of major morbidity, and the highest rate of 90-day mortality. While there were no differences in OS and PFS between primary closure and end-end anastomosis.
腹腔镜胰十二指肠切除术联合肠系膜门静脉切除重建（LPD-MPVRs）治疗胰头腺癌的结果鲜有报道。本研究旨在探讨不同类型 LPD-MPVRs 的短期和长期疗效。
选取 2014 年 6 月至 2020 年 12 月期间 14 家中国高容量胰腺中心行 LPD-MPVRs 的患者，并进行比较。
共纳入 142 例患者，分为直接缝合组（n=56）、端端吻合组（n=43）和间置移植组（n=43）。直接缝合组和端端吻合组的中位总生存期（OS）和中位无进展生存期（PFS）差异均无统计学意义（均 P＞0.05）。与直接缝合组和端端吻合组相比，间置移植组的中位 OS 最差（12 个月比 19 个月比 17 个月，P=0.001），中位 PFS 最差（6 个月比 15 个月比 12 个月，P＜0.000）。与直接缝合组相比，间置移植组主要并发症的风险几乎增加了一倍（16.3%比 8.9%），90 天死亡率增加了约两倍（10%比 3.6%），而端端吻合组的主要并发症发生率仅为四分之一（2.3%比 8.9%）。多因素分析显示，术后住院时间、美国麻醉医师协会（ASA）评分、阳性淋巴结数量对 OS 有负面影响，而 R0、R1 手术切缘对 OS 有保护作用。术后住院时间对 PFS 有负面影响，而直接缝合、端端吻合、短期血管通畅和短期血管狭窄与 PFS 呈正相关。
在 LPD-MPVRs 中，间置移植组的 OS、PFS 最差，主要并发症发生率和 90 天死亡率最高。而直接缝合组和端端吻合组的 OS 和 PFS 无差异。
