联合静脉血管切除的微创胰十二指肠切除术：与开放手术的对比分析
Minimally invasive pancreatoduodenectomy with combined venous vascular resection: A comparative analysis with open approach.
作者信息
Shin Dong Hyun, Choi Munseok, Rho Seoung Yoon, Hong Seung Soo, Kim Sung Hyun, Hwang Ho Kyoung, Kang Chang Moo
机构信息
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
出版信息
Ann Hepatobiliary Pancreat Surg. 2024 Nov 30;28(4):500-507. doi: 10.14701/ahbps.24-082. Epub 2024 Sep 24.
BACKGROUNDS/AIMS: This study aimed to compare the minimally invasive pancreatoduodenectomy with venous vascular resection (MI-PDVR) and open pancreatoduodenectomy with venous vascular resection (O-PDVR) for periampullary cancer.
METHODS
Data of 124 patients who underwent PDVR (45 MI-PDVR, 79 O-PDVR) between January 1, 2016, and December 31, 2023, was retrospectively reviewed.
RESULTS
MI-PDVR is significantly better than O-PDVR in terms of perioperative outcomes (median operation time [452.69 minutes vs. 543.91 minutes; = 0.004], estimated blood loss [410.44 mL vs. 747.59 mL; < 0.01], intraoperative transfusion rate [2 cases vs. 18 cases; = 0.01], and hospital stay [18.16 days vs. 23.91 days; = 0.008]). The complications until the discharge day showed no significant difference between the two groups (Clavien-Dindo < 3, 84.4% vs. 82.3%; Clavien-Dindo ≥ 3, 15.6% vs. 17.7%; = 0.809). In terms of long-term oncological outcomes, there was no statistical difference in overall survival (OS, 51.55 months [95% CI: 35.95-67.14] vs. median 49.92 months [95% CI: 40.97-58.87]; = 0.340) and disease-free survival (DFS, median 35.06 months [95% CI: 21.47-48.65] vs. median 38.77 months [95% CI: 29.80-47.75]; = 0.585), between the two groups. Long-term oncological outcomes for subgroup analysis focusing on pancreatic ductal adenocarcinoma also showed no statistical differences in OS (40.86 months [95% CI: 34.45-47.27] vs. 48.48 months [95% CI: 38.16-58.59]; = 0.270) and DFS (24.42 months [95% CI: 17.03-31.85] vs. 34.35 months, [95% CI: 25.44-43.27]; = 0.740).
CONCLUSIONS
MI-PDVR can provide better perioperative outcomes than O-PDVR, and has similar oncological impact.
背景/目的：本研究旨在比较微创胰十二指肠切除术联合静脉血管切除（MI-PDVR）与开放胰十二指肠切除术联合静脉血管切除（O-PDVR）治疗壶腹周围癌的效果。
方法
回顾性分析2016年1月1日至2023年12月31日期间接受PDVR的124例患者的数据（45例行MI-PDVR，79例行O-PDVR）。
结果
MI-PDVR在围手术期结局方面明显优于O-PDVR（中位手术时间[452.69分钟对543.91分钟；P = 0.004]、估计失血量[410.44毫升对747.59毫升；P < 0.01]、术中输血率[2例对18例；P = 0.01]以及住院时间[18.16天对23.91天；P = 0.008]）。两组至出院日的并发症无显著差异（Clavien-Dindo < 3，84.4%对82.3%；Clavien-Dindo≥3，15.6%对17.7%；P = 0.809）。在长期肿瘤学结局方面，两组的总生存期（OS，51.55个月[95%CI：35.95 - 67.14]对中位49.92个月[95%CI：40.97 - 58.87]；P = 0.340）和无病生存期（DFS，中位35.06个月[95%CI：21.47 - 48.65]对中位38.77个月[95%CI：29.80 - 47.75]；P = 0.585）无统计学差异。针对胰腺导管腺癌的亚组分析的长期肿瘤学结局在OS（40.86个月[95%CI：34.45 - 47.27]对48.48个月[95%CI：38.16 - 58.59]；P = 0.270）和DFS（24.42个月[95%CI：17.03 - 31.85]对34.35个月，[95%CI：25.44 - 43.27]；P = 0.740）方面也无统计学差异。
结论
MI-PDVR能提供比O-PDVR更好的围手术期结局，且具有相似的肿瘤学影响。
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