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：Dis...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.展开更多
Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatect...Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.展开更多
基金supported by the Zhejiang Provincial Natural Science Foundation of China(No.LY17H160026)
文摘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.
文摘Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.
