超重患者腹腔镜与开放胰十二指肠切除术的短期和长期结局比较：一项倾向评分匹配研究
Comparison of short‑ and long‑term outcomes between laparoscopic and open pancreaticoduodenectomy in overweight patients: a propensity score‑matched study.
作者信息
Xu Shuai, Xu Yinlong, Wang Shulin, Chu Qingsen, Zhang Huating, Gong Wei, Xu Yantian, Liu Jun
机构信息
Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China.
Department of Rehabilitation Medicine, The 960, Hospital of the PLA Joint Logistics Support Force, Jinan, 250031, Shandong, China.
出版信息
Surg Endosc. 2025 Feb;39(2):881-890. doi: 10.1007/s00464-024-11418-1. Epub 2024 Dec 3.
BACKGROUND
Overweight is thought to affect the outcome of minimally invasive surgery. There is still a lack of controlled studies of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) in overweight patients. This study was designed to compare short-term and long-term outcomes in overweight patients treated with LPD and OPD.
METHODS
Clinical and follow-up data on overweight patients who received LPD or OPD at Shandong Provincial Hospital from January 2015 to December 2022 were analyzed retrospectively. The bias between groups were balanced by 1:1 propensity score matching (PSM). Kaplan-Meier survival curves described long-term survival outcomes in overweight pancreatic ductal adenocarcinoma (PDAC) patients.
RESULTS
A total of 502 overweight patients were enrolled in the study. There were 276 patients in the LPD group and 226 in the OPD group. After matching, 196 patients were enrolled in each group. Compared with the OPD group, the LPD group had fewer estimated blood loss (EBL) (140 vs. 200 mL, P < 0.001), more lymph node dissection (14 vs. 12, P = 0.010), and shorter postoperative length of stay (LOS) (13 vs. 16 days, P < 0.001). There were no significant differences in severe complications, 90-day readmission and mortality rates (all P > 0.05). The subgroup analysis of obese patients also showed that the LPD group had fewer intraoperative EBL, more lymph node dissection, and shorter LOS. The survival analysis showed that overweight patients with PDAC who underwent LPD or OPD had similar overall survival (OS) (23.8 vs.25.7 months, P = 0.963) after PSM.
CONCLUSION
It is safe and feasible for overweight patients undergoing LPD to have less EBL, more lymph node harvesting, and a shorter LOS. There was no statistically significant difference in long-term survival outcomes among overweight PDAC patients between the two approaches.
背景
超重被认为会影响微创手术的结果。对于超重患者，腹腔镜胰十二指肠切除术（LPD）与开放胰十二指肠切除术（OPD）的对照研究仍然缺乏。本研究旨在比较接受LPD和OPD治疗的超重患者的短期和长期结局。
方法
回顾性分析2015年1月至2022年12月在山东省立医院接受LPD或OPD的超重患者的临床和随访数据。通过1:1倾向评分匹配（PSM）平衡组间偏差。Kaplan-Meier生存曲线描述超重胰腺导管腺癌（PDAC）患者的长期生存结局。
结果
本研究共纳入502例超重患者。LPD组276例，OPD组226例。匹配后，每组纳入196例患者。与OPD组相比，LPD组估计失血量（EBL）更少（140 vs. 200 mL，P < 0.001），淋巴结清扫更多（14 vs. 12，P = 0.010），术后住院时间（LOS）更短（13 vs. 16天，P < 0.001）。严重并发症、90天再入院率和死亡率无显著差异（所有P > 0.05）。肥胖患者的亚组分析也显示，LPD组术中EBL更少，淋巴结清扫更多，LOS更短。生存分析显示，PSM后接受LPD或OPD的超重PDAC患者的总生存期（OS）相似（23.8 vs. 25.7个月，P = 0.963）。
结论
超重患者接受LPD手术时，减少EBL、增加淋巴结清扫和缩短LOS是安全可行的。两种手术方式治疗超重PDAC患者的长期生存结局无统计学显著差异。
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