University of Texas Southwestern, Department of Surgery, Dallas, TX, USA.
University of Texas Southwestern, Harold C. Simmons Cancer Center, Dallas, TX, USA.
J Gastrointest Surg. 2023 Dec;27(12):2823-2842. doi: 10.1007/s11605-023-05859-7. Epub 2023 Oct 30.
There is an increasing use of neoadjuvant treatment (NAT) for pancreatic cancer (PC) followed by minimally invasive pancreatoduodenectomy (MIPD). We evaluate the impact of the surgical approach on 30-day outcomes in PC patients who underwent NAT.
Patients with PC who had NAT followed by MIPD or open pancreatoduodenectomy (OPD) were identified from a pancreatectomy-targeted dataset (2014-2020) of the National Surgical Quality Improvement Program. Comparisons were made between MIPD and OPD within NAT groups.
A total of 5588 patients were analyzed. Of those, 4907 underwent OPD and 476 underwent MIPD. In addition, 3559 patients received neoadjuvant chemotherapy alone and 1830 received neoadjuvant chemoradiation. In the chemotherapy-alone group, the MIPD subgroup had lower rates of any complication (38.2% vs. 45.8%, P = 0.005), but there were no differences in mortality (2.1% for MIPD vs 1.9% for OPD, P=0.8) or serious complication (11.8% for MIPD vs 15% for OPD, P=0.1). On multivariable analysis, MIPD was independently predictive of lower rates of any complication (OR: 0.74, 95% CI 0.6-0.93, P = 0.0009), CR-POPF (OR: 0.58, 95% CI 0.35-0.96, P = 0.04), and shorter LOS (estimate: -1.03, 95% CI -1.73 to -0.32, P = 0.004). In the chemoradiation group, patients undergoing MIPD had higher rates of preoperative diabetes (P < 0.05), but there were no significant differences in any outcomes between the two approaches in this group.
MIPD is safe and feasible after NAT. Patients having neoadjuvant chemotherapy alone followed by MIPD had lower rates of complications, shorter LOS, and fewer CR-POPFs compared to OPD.
新辅助治疗（NAT）后行微创胰十二指肠切除术（MIPD）治疗胰腺癌（PC）的应用日益增多。我们评估了 NAT 后接受手术治疗的 PC 患者的手术方式对 30 天结局的影响。
从国家手术质量改进计划的胰腺切除术靶向数据集（2014-2020 年）中确定接受 NAT 后行 MIPD 或开放胰十二指肠切除术（OPD）的 PC 患者。在 NAT 组内比较 MIPD 和 OPD。
共分析了 5588 例患者，其中 4907 例行 OPD，476 例行 MIPD。此外，3559 例患者接受单纯新辅助化疗，1830 例患者接受新辅助放化疗。在单纯化疗组中，MIPD 亚组的任何并发症发生率较低（38.2% vs. 45.8%，P = 0.005），但死亡率无差异（MIPD 为 2.1%，OPD 为 1.9%，P=0.8）或严重并发症（MIPD 为 11.8%，OPD 为 15%，P=0.1）。多变量分析显示，MIPD 可独立预测较低的任何并发症发生率（OR：0.74，95%CI 0.6-0.93，P = 0.0009）、CR-POPF（OR：0.58，95%CI 0.35-0.96，P = 0.04）和较短的 LOS（估计值：-1.03，95%CI -1.73 至 -0.32，P = 0.004）。在放化疗组中，行 MIPD 的患者术前糖尿病发生率较高（P < 0.05），但两种方法在该组的任何结局之间均无显著差异。
NAT 后行 MIPD 安全可行。与 OPD 相比，单独接受新辅助化疗后行 MIPD 的患者并发症发生率较低，LOS 较短，CR-POPF 较少。
