Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy.
Curr Oncol. 2024 Oct 11;31(10):6096-6109. doi: 10.3390/curroncol31100455.
Minimally invasive pancreatic resections (MIPRs) have been shown to be safe and feasible, but there is still a lack of high-level evidence on oncological outcomes for cephalic pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to compare the oncological outcomes of patients undergoing MIPR and open pancreatic resection (OPR) for pancreatic head cancer in a single high-volume center.
Data from a prospectively collected database of patients who underwent radical-intent surgery for resectable and borderline resectable PDAC of the head at our institution between January 2013 and May 2023 were retrieved and analyzed, comparing the surgical and oncological outcomes of MIPR and OPR, using a propensity score matching analysis.
In the study period, 220 patients were selected. After matching, a total of 81 MIPRs and 81 OPRs were compared. No difference was found regarding R0 rate (OPR 83.9% vs. MIPR 74.1%, = 0.122). Median overall survival (24 and 31 months for the OPR and MIPR groups, respectively; log rank = 0.665) and disease-free survival (12 and 21 months for the OPR and MIPR groups, respectively; log rank = 0.118) did not differ between the groups. The MIPR group was associated with a greater number of harvested lymph nodes (22 vs. 16, = 0.0008), longer operative time (565 vs. 420 min, < 0.0001), and shorter length of stay (12 vs. 18 days; = 0.0001). No differences between the groups were found regarding all other postoperative and pathological outcomes.
Regarding oncological outcomes, MIPR appeared to be comparable to OPR for treating patients with PDAC of the head. Despite an increased operative time, MIPR was associated with a greater number of LNs harvested and a shorter length of stay.
微创胰腺切除术（MIPR）已被证明是安全且可行的，但对于头部胰腺导管腺癌（PDAC）的肿瘤学结果仍缺乏高级别的证据。本研究的目的是比较在单一高容量中心接受 MIPR 和开放式胰腺切除术（OPR）治疗头部胰腺癌症患者的肿瘤学结果。
从 2013 年 1 月至 2023 年 5 月期间，在我们机构接受根治性手术治疗可切除和交界可切除的头部 PDAC 的患者前瞻性收集数据库中检索并分析数据，使用倾向评分匹配分析比较 MIPR 和 OPR 的手术和肿瘤学结果。
在研究期间，选择了 220 名患者。匹配后，比较了总共 81 例 MIPR 和 81 例 OPR。R0 率无差异（OPR 为 83.9%，MIPR 为 74.1%， = 0.122）。中位总生存期（OPR 组和 MIPR 组分别为 24 个月和 31 个月；对数秩 = 0.665）和无病生存期（OPR 组和 MIPR 组分别为 12 个月和 21 个月；对数秩 = 0.118）在两组之间无差异。MIPR 组采集的淋巴结数量更多（22 对 16， = 0.0008），手术时间更长（565 对 420 分钟， < 0.0001），住院时间更短（12 对 18 天； = 0.0001）。两组在所有其他术后和病理结果方面无差异。
就肿瘤学结果而言，MIPR 似乎与 OPR 治疗头部 PDAC 患者相当。尽管手术时间延长，但 MIPR 与更多的淋巴结采集和较短的住院时间相关。
