Karam Elias, Rondé-Roupie Charlotte, Aussilhou Béatrice, Hentic Olivia, Rebours Vinciane, Lesurtel Mickaël, Sauvanet Alain, Dokmak Safi
Department of Hepato-biliary-Pancreatic Surgery and Liver Transplantation, APHP, Hôpital Beaujon, DMU DIGEST, Clichy, France; Visceral Surgery Unit, Tours University Hospital, France.
Department of Hepato-biliary-Pancreatic Surgery and Liver Transplantation, APHP, Hôpital Beaujon, DMU DIGEST, Clichy, France.
Surgery. 2025 Feb;178:108892. doi: 10.1016/j.surg.2024.09.041. Epub 2024 Nov 1.
Few studies compared laparoscopic and open pancreatoduodenectomy for pancreatic ductal adenocarcinoma after neoadjuvant chemoradiotherapy.
Retrospective cohort of patients who underwent laparoscopic or open pancreatoduodenectomy for resectable or borderline resectable pancreatic ductal adenocarcinoma after chemoradiotherapy between 2012 and 2023 was analyzed. Open pancreatoduodenectomy patients could theoretically benefit from the laparoscopic approach. We used a 1:2 (laparoscopic-to-open pancreatoduodenectomy) propensity score matching analysis stratified on age, gender, and body mass index.
We included 128 patients (33 laparoscopic and 95 open pancreatoduodenectomy), and after propensity score matching, 33 laparoscopic pancreatoduodenectomy and 66 open pancreatoduodenectomy were compared. There was no difference in demographic data except for lower tobacco use in laparoscopic pancreatoduodenectomy group (9% vs 30%, P = .023) with similar clinical presentation. Laparoscopic pancreatoduodenectomy compared to open pancreatoduodenectomy showed a longer median operative duration (380 vs 255 minutes, P < .001), shorter median length of resected vein (15 vs 23 mm, P = .01), longer median venous clamping time (29 vs 15 minutes, P = .005), similar median blood loss (300 vs 300 mL, P = .223), similar rate of hard pancreas (97% vs 85%, P = .094), and a larger median size of Wirsung duct (5 vs 4 mm, P = .02). Postoperative outcomes showed similar 90-day mortality rates (3% vs 3%, P > .99), Clavien-Dindo III-IV complications (6% vs 14%, P = .158), median lengths of hospital stay (12 vs 13 days, P = .409), and readmission rates (9% vs 18%, P = .366). Pathologic data showed similar R0 resection rates (88% vs 82%, P = .568). With a similar rate of adjuvant chemotherapy (P = .324) and shorter median follow-up with laparoscopic pancreatoduodenectomy (18 vs 34 months, P = .004), 3-year overall (P = .768) and disease-free (P = .839) survival rates were similar.
In selected patients, laparoscopic pancreatoduodenectomy for pancreatic ductal adenocarcinoma after neoadjuvant chemoradiotherapy appears to be safe and feasible when performed in experienced centers.
很少有研究比较新辅助放化疗后腹腔镜与开放胰十二指肠切除术治疗胰腺导管腺癌的效果。
分析2012年至2023年间接受腹腔镜或开放胰十二指肠切除术治疗可切除或临界可切除胰腺导管腺癌的患者的回顾性队列。理论上，开放胰十二指肠切除术患者可从腹腔镜手术中获益。我们采用1:2（腹腔镜与开放胰十二指肠切除术）倾向评分匹配分析，按年龄、性别和体重指数进行分层。
我们纳入了128例患者（33例行腹腔镜胰十二指肠切除术，95例行开放胰十二指肠切除术），倾向评分匹配后，比较了33例行腹腔镜胰十二指肠切除术和66例行开放胰十二指肠切除术的患者。除腹腔镜胰十二指肠切除术组吸烟率较低（9%对30%，P = 0.023）外，两组人口统计学数据无差异，临床表现相似。与开放胰十二指肠切除术相比，腹腔镜胰十二指肠切除术的中位手术时间更长（380对255分钟，P < 0.001），切除静脉的中位长度更短（15对23毫米，P = 0.01），静脉夹闭中位时间更长（29对15分钟，P = 0.005），中位失血量相似（300对300毫升，P = 0.223），胰腺质地硬的比例相似（97%对85%，P = 0.094），主胰管中位直径更大（5对4毫米，P = 0.02）。术后结果显示90天死亡率相似（3%对3%，P > 0.99），Clavien-Dindo III-IV级并发症发生率相似（6%对14%，P = 0.158），中位住院时间相似（12对13天，P = 0.409），再入院率相似（9%对18%，P = 0.366）。病理数据显示R0切除率相似（88%对82%，P = 0.568）。辅助化疗率相似（P = 0.324），腹腔镜胰十二指肠切除术的中位随访时间更短（18对34个月，P = 0.004），3年总生存率（P = 0.768）和无病生存率（P = 0.839）相似。
在经验丰富的中心进行新辅助放化疗后，对选定患者行腹腔镜胰十二指肠切除术治疗胰腺导管腺癌似乎是安全可行的。
