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

Abstract

Objective

The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (LDP) 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 LDP. No patients with locally advanced lesions were included in this study. Comparing LDP group to LDP 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 LDP group, P=0.44) nor the rate of patients with positive lymph nodes (36% in LDP group vs. 41% in LDP group, P=0.71). Incidence of positive margins was similar (9% in LDP group vs. 13% in LDP 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 LDP 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.

摘要

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。