Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma:a single-center experience

腹腔镜与开腹胰体尾切除术对胰腺导管腺癌的治疗经验（英文）

Objective：The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy（LDP）and open distal pancreatectomy（ODP）at a single center.Methods：Distal pancreatectomies performed for pancreatic ductal adenocarcinoma during a 4-year period were included in this study.A retrospective analysis of a database of this cohort was conducted.Results：Twenty-two patients underwent LDP for pancreatic ductal adenocarcinoma,in comparison to seventy-six patients with comparable tumor characteristics treated by ODP.No patients with locally advanced lesions were included in this study.Comparing LDP group to ODP group,there were no significant differences in operation time（P=0.06）or blood loss（P=0.24）.Complications（pancreatic fistula,P=0.62;intra-abdominal abscess,P=0.44;postpancreatectomy hemorrhage,P=0.34）were similar.There were no significant differences in the number of lymph nodes harvested（11.2±4.6 in LDP group vs.14.4±5.5 in ODP group,P=0.44）nor the rate of patients with positive lymph nodes（36%in LDP group vs.41%in ODP group,P=0.71）.Incidence of positive margins was similar（9%in LDP group vs.13%in ODP group,P=0.61）.The mean overall survival time was（29.6±3.7）months for the LDP group and（27.6±2.1）months for ODP group.There was no difference in overall survival between the two groups（P=0.34）.Conclusions：LDP is a safe and effective treatment for selected patients with pancreatic ductal adenocarcinoma.A slow-compression of pancreas tissue with the GIA stapler is effective in preventing postoperative pancreatic fistula.The oncologic outcome is comparable with the conventional open approach.Laparoscopic radical antegrade modular pancreatosplenectomy contributed to oncological clearance.

目的:评估腹腔镜(LDP)与开腹胰体尾切除术(ODP)的并发症发生率和肿瘤清除效果。创新点:本组病例的腹腔镜手术组采用endo-GIA缓慢压榨方法处理胰腺残端,并采用根治性顺行模块化胰脾切除术,获得了较低的术后胰漏发生率和良好的手术清除效果。方法:收集4年间实施胰体尾切除手术的胰腺导管腺癌病例资料,进行回顾性分析。结论:22例胰腺导管腺癌进行了LDP手术,76例病人进行了ODP手术。比较LDP和ODP组,两组在胰漏(P=0.62)、腹腔内脓肿(P=0.44)和术后出血(P=0.34)发生率无显著性差异。LDP组和ODP组术中获取的淋巴结数量(11.2±4.6 vs.14.4±5.5,P=0.44)和淋巴结阳性病例数(36%vs.41%,P=0.71)无显著性差异。切缘阳性发生率(9%vs.13%,P=0.61)也无显著性差异。LDP组平均生存期(29.6±3.7)月,ODP组为(27.6±2.1)月,无显著性差异(P=0.35)。综上所述,腹腔镜胰体尾切除术对早期的胰腺导管癌是安全有效的。采用endo-GIA缓慢压榨方法可以预防术后胰漏发生,腹腔镜下根治性顺行模块化胰腺切除有利于肿瘤清除。腹腔镜手术可以达到和传统开腹手术相似的肿瘤清除效果。