腹腔镜下“无接触” RAMPS 联合“接触”左胰体尾切除术治疗胰腺腺癌的肿瘤学结果。

Oncological Outcome After Laparoscopic 'No-touch' RAMPS 'Touch' Left Pancreatectomy for Pancreatic Adenocarcinoma.

机构信息

Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France;

Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

Anticancer Res. 2023 Nov;43(11):4983-4991. doi: 10.21873/anticanres.16697.

DOI:10.21873/anticanres.16697

PMID:37909963

Abstract

BACKGROUND/AIM: The validity of laparoscopic distal pancreatectomy in left-sided pancreatic adenocarcinoma (PDAC) is still unclear. However, a meticulous surgical dissection through a "no-touch" technique might allow a radical oncological resection with minimal risk of tumor dissemination and seeding. This study aimed to evaluate the oncological outcomes of the laparoscopic "no touch" technique versus the "touch" technique.

PATIENTS AND METHODS

From 2001 to 2020, we retrospectively analyzed 45 patients undergoing laparoscopic distal pancreatectomy (LDP) for PDAC in two centers. Factors associated with overall (OS), disease-free survival (DFS) and time to recurrence (TTR) were identified.

RESULTS

The OS rates in the 'no-touch' and 'touch' groups were 95% vs. 78% (1-year OS); 50% vs. 50% (3-year OS), respectively (p=0.60). The DFS rates in the 'no-touch' and 'touch' groups were 72 % vs. 57% (1-year DFS); 32% vs. 28% (3-year DFS), respectively (p=0.11). The TTR rates in the 'no-touch' and 'touch' groups were 77% vs. 61% (1-year TTR); 54% vs. 30% (3-year TTR); 46% vs. 11% (5-year TTR); respectively (p=0.02) In multivariate analysis the only factors were Touch technique [odds ratio (OR)=2.62, p=0.02] and lymphovascular emboli (OR=4.8; p=0.002).

CONCLUSION

We advise the 'no-touch' technique in patients with resectable PDAC in the pancreatic body and tail. Although this study does not provide definitive proof of superiority, no apparent downsides are present for the 'no-touch' technique in this setting although there could be oncological benefits.

摘要

背景/目的：腹腔镜胰体尾切除术治疗左侧胰腺腺癌（PDAC）的有效性尚不清楚。然而，通过“无接触”技术进行细致的手术解剖，可能会实现根治性肿瘤切除，同时最大限度地降低肿瘤播散和种植的风险。本研究旨在评估腹腔镜“无接触”技术与“接触”技术的肿瘤学结果。

患者与方法

我们回顾性分析了 2001 年至 2020 年间在两个中心接受腹腔镜胰体尾切除术（LDP）治疗 PDAC 的 45 例患者。确定了与总生存期（OS）、无病生存期（DFS）和复发时间（TTR）相关的因素。

结果

“无接触”组和“接触”组的 OS 率分别为 95%和 78%（1 年 OS）；50%和 50%（3 年 OS）（p=0.60）。“无接触”组和“接触”组的 DFS 率分别为 72%和 57%（1 年 DFS）；32%和 28%（3 年 DFS）（p=0.11）。“无接触”组和“接触”组的 TTR 率分别为 77%和 61%（1 年 TTR）；54%和 30%（3 年 TTR）；46%和 11%（5 年 TTR）（p=0.02）。多因素分析显示，唯一的因素是接触技术[比值比（OR）=2.62，p=0.02]和脉管浸润（OR=4.8；p=0.002）。