腹腔镜胰十二指肠切除术及腹腔镜全胰切除术治疗胰腺癌的单中心临床分析

Single-center clinical analysis of laparoscopic pancreaticoduodenectomy and laparoscopic total pancreatectomy for treating pancreatic cancer

目的分析腹腔镜胰十二指肠切除术(LPD)及腹腔镜全胰切除术(LTP)治疗胰腺癌的安全性和治疗效果。方法回顾性分析2018年12月至2023年8月间北京协和医院基本外科行LPD或LTP的87例胰头颈癌患者临床资料。记录患者的手术方式、手术时间、术中出血量、中转开腹率、围术期死亡率、二次手术发生率、术后主要并发症发生率、术后住院时间、淋巴结清扫个数、肿瘤病理分期、R0切除率、术后化疗开始时间、生存结果等。随访时间截至2023年9月。结果87例患者中78例(89.7%)行LPD,9例(10.3%)行LTP。16例(18.4%)行门静脉-肠系膜上静脉(PV-SMV)血管切除重建,其中11例在完全腹腔镜下完成。中转开腹5例(5.7%)。手术时间(279.8±74.0)min,术中出血(520.1±743.2)ml。总住院时间(15.9±6.3)d,术后住院时间(11.5±6.0)d。术后主要并发症发生率19.5%,其中术后胆瘘4例(4.6%),术后胃排空障碍6例(6.9%),术后出血3例(3.4%),二次手术、围术期死亡均为1例(1.1%)。LPD患者中,术后B级以上胰瘘5例(6.4%)。高龄(≥70岁)不增加围术期并发症发生率。所有患者均为R0切除。淋巴结清扫个数(25.9±11.4)个。术后开始化疗时间(2.13±1.43)个月。术后中位生存期为16个月。结论在高流量的胰腺病中心,LPD和LTP用于治疗胰腺癌患者是安全可行的,并可达到满意的肿瘤根治效果,改善患者预后。

Objective To analyze the safety and therapeutic efficacy of laparoscopic pancreaticoduodenectomy(LPD)and laparoscopic total pancreatectomy(LTP)in the treatment of pancreatic cancer.Methods Clinical data of 87 patients with pancreatic head and neck cancer who underwent LPD or LTP in the Department of General Surgery at Peking Union Medical College Hospital from December 2018 to August 2023 were retrospectively analyzed.The surgical approach,operative time,intraoperative blood loss volume,conversion rate to open surgery,perioperative mortality,re-operative rate,rate of major postoperative complications,postoperative hospital stay,number of lymph nodes harvested,tumor pathological stage,R0 resection rate,initiation of postoperative chemotherapy and survival outcomes were recorded.The follow-up period extended until September 2023.Results Among the 87 patients,78(89.7%)underwent LPD and 9(10.3%)underwent LTP.PV-SMV vascular resection and reconstruction was performed in 16 cases(18.4%),and 11 cases totally underwent laparoscopy.Five cases(5.7%)required conversion to open surgery.The mean operative time was 279.8±74.0 minutes,and the mean intraoperative blood loss volume was 520.1±743.2 ml.The overall length of hospital stay was 15.9±6.3 days,with a mean postoperative hospital stay of 11.5±6.0 days.The rate of major postoperative complications was 19.5%,including 4 cases(4.6%)of postoperative bile leakage,6 cases(6.9%)of postoperative gastric emptying disorders,and 3 cases(3.4%)of postoperative bleeding.There was one case(1.1%)with secondary surgery and one case(1.1%)with perioperative death.Among LPD patients,5 cases(6.4%)had postoperative grade B or higher pancreatic fistula.Advanced age(≥70 years)did not increase the incidence of perioperative complications.All patients achieved R0 resection.The mean number of lymph nodes harvested was 25.9±11.4.The median time to initiation of postoperative chemotherapy was 2.13±1.43 months.The median overall survival was 16 months.Conclusions In a high-volume center for pancreatic diseases,LPD and LTP are safe and feasible for the treatment of pancreatic cancer,which could achieve satisfactory anti-tumor efficacy and improve patients'prognosis.