Pastier Clément, Gregory Jules, Chouillard Marc-Anthony, Aussilhou Béatrice, Rebours Vinciane, Lesurtel Mickael, Sauvanet Alain, Dokmak Safi
Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Beaujon Hospital, AP-HP, Clichy, France.
Department of Radiology, Beaujon Hospital, AP-HP, FHU MOSAIC, Clichy, France; Université de Paris Cité, Paris, France.
Surgery. 2025 Jun 19;184:109442. doi: 10.1016/j.surg.2025.109442.
Laparoscopic central pancreatectomy (LCP) is usually proposed for non-malignant neck-body neoplasms, but it can be proposed for head-neck lesions to avoid pancreaticoduodenectomy or for body-tail lesions to avoid distal pancreatectomy. The aim of this study was to classify CP on the basis of the proximal resection level.
We retrospectively studied all consecutive LCPs performed in our institution from 2011 to 2024. LCP can be associated with vascular procedures (gastroduodenal artery or splenic vessels) and was classified into 3 types according to proximal level of pancreatic resection: head-LCP, neck-LCP, and body-LCP (results in this order). The primary objective of this study was the creation and definition of this new classification for LCP. The secondary objectives were to compare outcomes and textbook outcome (TBO) completion, defined as no clinically relevant postoperative pancreatic fistula, no clinically relevant postpancreatectomy hemorrhage, no bile leaks, no readmission, no mortality, and no severe morbidity within 90 postoperative days.
In total, 109 patients underwent LCP with head-LCP, neck-LCP, and body-LCP observed in 20%, 66%, and 14%, respectively. The type was correlated with the distance of the lesion from the gastroduodenal artery (P = .0001). Head and body-LCPs were more frequently associated with vascular procedures (68% vs 17% vs 40%, P = .001) and body-LCP was associated with larger tumor size (millimeters) compared with head and neck-LCPs (17 vs 21 vs 35, P = .07). TBO did not differ significantly (41% vs 58% vs 47%, P = .31) with one patient death (mortality <1%). At median follow-up (22 months), the rate of new-onset exocrine (6%; P = .10) or endocrine (4%; P = .76) pancreatic insufficiencies was similar. On multivariate analysis, only American Society of Anesthesiologists score ≥2 (P = .03) and pancreatic texture (P = .01) were prognostic factors for TBO while LCP type was not.
Head and neck-LCPs were more challenging as assessed by the associated vascular procedures without impact on TBO, allowing in some selected patients parenchymal-sparing surgery. Further studies comparing CP with standard pancreatic resections are needed.
腹腔镜胰体尾切除术（LCP）通常用于治疗非恶性的胰颈体部肿瘤，但也可用于胰头颈部病变以避免胰十二指肠切除术，或用于胰体尾部病变以避免胰体尾切除术。本研究的目的是根据近端切除水平对胰体尾切除术进行分类。
我们回顾性研究了2011年至2024年在本机构进行的所有连续性LCP。LCP可与血管手术（胃十二指肠动脉或脾血管）联合进行，并根据胰腺切除的近端水平分为3种类型：胰头-LCP、胰颈-LCP和胰体-LCP（按此顺序排列结果）。本研究的主要目的是创建并定义这种新的LCP分类。次要目的是比较手术结果和教科书式手术结果（TBO）的完成情况，TBO定义为术后90天内无临床相关的胰瘘、无临床相关的胰切除术后出血、无胆漏、无再次入院、无死亡以及无严重并发症。
共有109例患者接受了LCP，其中胰头-LCP、胰颈-LCP和胰体-LCP分别占20%、66%和14%。这种类型与病变距胃十二指肠动脉的距离相关（P = .0001）。胰头和胰体-LCP与血管手术的关联更为频繁（68%对17%对40%，P = .001），与胰头和胰颈-LCP相比，胰体-LCP与更大的肿瘤大小（毫米）相关（17对21对35，P = .07）。TBO无显著差异（41%对58%对47%，P = .31），有1例患者死亡（死亡率<1%）。在中位随访期（22个月），新发外分泌性（6%；P = .10）或内分泌性（4%；P = .76）胰腺功能不全的发生率相似。多因素分析显示，只有美国麻醉医师协会评分≥2（P = .03）和胰腺质地（P = .01）是TBO的预后因素，而LCP类型不是。
通过相关血管手术评估，胰头和胰颈-LCP更具挑战性，但对TBO无影响，这使得在一些选定患者中可以进行保留实质的手术。需要进一步开展比较胰体尾切除术与标准胰腺切除术的研究。
