Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr. Manhasset, Manhasset, NY, 11030, USA.
Department of Surgery, UT Health San Antonio, San Antonio, TX, USA.
Langenbecks Arch Surg. 2024 Aug 22;409(1):258. doi: 10.1007/s00423-024-03454-1.
Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) presents a significant challenge owing to its aggressive nature. Traditionally performed as open surgery, the advent of minimally invasive surgery (MIS) including laparoscopic and robotic techniques, offers a potential alternative. This study assessed the use and outcomes of MIS and open PD for PDAC treatment.
We analyzed ACS-NSQIP data (2015-2021) using regression models to compare patient outcomes across open PD, MIS PD, and conversions from MIS to open (MIS-O).
Of 19,812 PDAC patients, 1,293 (6.53%) underwent MIS, 18,116 (91.44%) underwent open PD, and 403 (2.03%) underwent MIS converted to open PD (MIS-O). The MIS rate increased from 6.1% to 9.2%. Black patients had a higher MIS-O rate (RR, 1.55; p = 0.025). Open PD was associated with more severe conditions (ASA ≥ III, malnutrition) and prior radiation therapy. MIS patients more often had neoadjuvant chemotherapy. Complex procedures, such as vein resection, favored open PD. Need for arterial resection was associated with MIS-O (RR, 2.11; p = 0.012), and operative time was significantly associated with MIS (OR: 4.32, 95% CI: 3.43-5.43, p-value: < 0.001) No differences in the overall morbidity or 30-day mortality were observed. MIS led to shorter stays but higher risks of reoperation and pulmonary embolism. MIS-O increased the delayed gastric emptying rate (RR, 1.79; p < 0.001).
During 2015-2021, an increasing number of patients with PDAC are undergoing MIS PD. Morbidity and mortality did not differ between open and MIS PD. MIS was performed more frequently in patients with better nutritional status and lower ASA, or when vascular resection was not anticipated. In well selected patients, short-term outcomes of MIS and open PD seem similar.
由于胰腺癌（PDAC）具有侵袭性，因此进行胰十二指肠切除术（PD）具有很大的挑战性。微创外科（MIS），包括腹腔镜和机器人技术的出现，为这种手术提供了一种潜在的替代方法。本研究评估了 MIS 和开腹 PD 治疗 PDAC 的应用和结果。
我们使用回归模型分析了 ACS-NSQIP 数据（2015-2021 年），以比较开腹 PD、MIS PD 和从 MIS 转为开腹（MIS-O）患者的治疗效果。
在 19812 例 PDAC 患者中，1293 例（6.53%）接受了 MIS，18116 例（91.44%）接受了开腹 PD，403 例（2.03%）接受了 MIS 转为开腹 PD（MIS-O）。MIS 率从 6.1%增加到 9.2%。黑人患者的 MIS-O 率更高（RR，1.55；p=0.025）。开腹 PD 与更严重的疾病（ASA≥III 级、营养不良）和先前的放射治疗有关。MIS 患者更多地接受新辅助化疗。静脉切除术等复杂手术有利于开腹 PD。需要动脉切除术与 MIS-O 相关（RR，2.11；p=0.012），手术时间与 MIS 显著相关（OR：4.32，95%CI：3.43-5.43，p 值：<0.001）。两组总并发症发生率或 30 天死亡率无差异。MIS 导致住院时间缩短，但再手术和肺栓塞风险增加。MIS-O 增加了胃排空延迟率（RR，1.79；p<0.001）。
在 2015-2021 年期间，越来越多的 PDAC 患者接受 MIS PD。开腹 PD 和 MIS PD 的发病率和死亡率无差异。MIS 更常用于营养状况较好、ASA 较低或预计无需血管切除的患者。在选择合适的患者中，MIS 和开腹 PD 的短期治疗效果似乎相似。
