Gao Qinglun, Liu Jingjing, Zhang Yuxiao, Wang Shulin, Si Wei, Xu Shuai
Hepatobiliary Surgery, Shandong Provincial Third Hospital, Shandong Province, Jinan, 250031, China.
Department of Anesthesiology, Chinese People's Armed Police Force Hospital of Beijing, Beijing, 100027, China.
Surg Endosc. 2025 Mar;39(3):2062-2072. doi: 10.1007/s00464-025-11584-w. Epub 2025 Jan 31.
Distal cholangiocarcinoma (dCCA) is an aggressive malignancy with poor prognosis. This study aimed to compare the short-term and long-term outcomes and "textbook outcome (TO)" between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for dCCA after the learning curve of surgeons.
Clinical and follow-up data were included for dCCA patients treated with LPD or OPD at our center between January 2017 and December 2022. The propensity score matching (PSM) method was used to minimize bias between groups. Univariate and multivariate logistic regression analyses were used to determine independent prognostic factors for TO.
A total of 430 patients were enrolled in the study, 224 in the LPD group and 206 in the OPD group. After PSM, 184 patients were included in each group. There were no significant differences in operative duration, lymph nodes harvest, intraoperative transfusion, vascular resection, R0 resection, severe complications, readmission rate, 30-day mortality, TO, and long-term prognosis between the two groups before and after PSM (all P > 0.05). Compared with OPD, LPD had less estimated blood loss (160 vs. 250mL, P < 0.001) and shorter postoperative length of stay (13 vs. 16 days, P < 0.001). Multivariate analysis showed that texture of pancreas [hard vs. soft, Odds Ratio (OR) 2.016; 95% confidence interval (CI) 1.276-3.184; P = 0.003] and operation duration (> 360 min vs. ≤ 360 min, OR 0.595, 95% CI 0.375-0.944, P = 0.027) were independent prognostic factors for TO.
After learning curve, LPD is safe and feasible for the treatment of dCCA, with the advantages of less intraoperative blood loss and faster postoperative recovery.
远端胆管癌（dCCA）是一种侵袭性恶性肿瘤，预后较差。本研究旨在比较外科医生度过学习曲线后，腹腔镜胰十二指肠切除术（LPD）和开放胰十二指肠切除术（OPD）治疗dCCA的短期和长期结局以及“教科书式结局（TO）”。
纳入2017年1月至2022年12月在本中心接受LPD或OPD治疗的dCCA患者的临床和随访数据。采用倾向评分匹配（PSM）方法以最小化组间偏差。单因素和多因素逻辑回归分析用于确定TO的独立预后因素。
本研究共纳入430例患者，LPD组224例，OPD组206例。PSM后，每组纳入184例患者。PSM前后两组在手术时间、淋巴结清扫、术中输血、血管切除、R0切除、严重并发症、再入院率、30天死亡率、TO和长期预后方面均无显著差异（所有P>0.05）。与OPD相比，LPD的估计失血量更少（160 vs. 250mL，P<0.001），术后住院时间更短（13 vs. 16天，P<0.001）。多因素分析显示，胰腺质地[硬 vs. 软，优势比（OR）2.016；95%置信区间（CI）1.276 - 3.184；P = 0.003]和手术时间（>360分钟 vs.≤360分钟，OR 0.595，95%CI 0.375 - 0.944，P = 0.027）是TO的独立预后因素。
度过学习曲线后，LPD治疗dCCA安全可行，具有术中失血少、术后恢复快的优点。
