通过倾向得分匹配分析比较腹腔镜与开腹胰十二指肠切除术治疗胰腺腺癌的效果

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery Pub Date : 2024-08-28 DOI:10.1016/j.lers.2024.08.001

Jared Mount , Brandon Mount , Katherine Poruk , Mary Tice , John A. Stauffer

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引用次数: 0

摘要

目的在以前的研究中，腹腔镜胰十二指肠切除术（LPD）已证明比开腹胰十二指肠切除术（OPD）治疗胰腺腺癌（PDAC）安全且具有潜在的优势。在常规实践中交替使用 LPD 和 OPD 手术十年之后，我们在一家医疗机构分析并比较了 LPD 和 OPD 治疗 PDAC 的结果。我们的主要目的是比较PDAC患者LPD和OPD的特征，以便为每个人选择合适的手术方法。方法从2010年1月到2020年12月，对所有接受胰十二指肠切除术（PD）的患者进行识别，并前瞻性地收集信息。在一家医疗机构中，共有589名患者接受了胰十二指肠切除术，其中347名为OPD患者，242名为LPD患者。在排除因 PDAC、全胰切除术、主要血管或伴随器官切除术以外的适应症而接受胰腺切除术的患者后，共有 237 例患者（OPD = 157 例，LPD = 80 例）。然后完成倾向评分匹配，对77名OPD患者和77名LPD患者进行分析，以建立一个相似的PDAC患者群体，即接受LPD或OPD的患者。结果LPD的手术时间（491分钟 vs. 281分钟，p < 0.001）长于OPD。LPD的胰瘘（11.7% 对 0.0%，p < 0.001）和胃排空延迟（15.6% 对 3.9%，p = 0.027）发生率分别高于 OPD，但总体发病率相似。两组的失血量、死亡率和胰腺切除术后出血量也相似，但LPD的总费用（60,245美元对50,900美元，p = 0.002）明显高于OPD。两组患者的复发率和总生存率相似。

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A comparison of laparoscopic to open pancreaticoduodenectomy for pancreatic adenocarcinoma by propensity score matching analysis

Objective

In previous studies, laparoscopic pancreaticoduodenectomy (LPD) has demonstrated safety and potential benefits over open pancreaticoduodenectomy (OPD) for pancreatic adenocarcinoma (PDAC). After performing both LPD and OPD procedures interchangeably in routine practice for a decade, the outcomes of LPD versus OPD for PDAC were analyzed and compared at a single institution. Our primary aim was to compare features of LPD and OPD in PDAC patients so that the suitable surgical approach may be chosen for each individual.

Methods

From January 2010 through December 2020, all patients undergoing pancreaticoduodenectomy (PD) were identified, and information was collected prospectively. At a single institution, PD was performed on 589 patients, of whom 347 were OPD patients and 242 were LPD patients. After excluding those who underwent pancreatectomy for indications other than PDAC, total pancreatectomy, major vascular or concomitant organ resection, there were 237 patients (OPD = 157, LPD = 80). Then propensity score matching was completed to analyze 77 OPD patients versus 77 LPD patients to create a similar group of patients who underwent either LPD or OPD for PDAC. A comparison of perioperative data and 90-day outcomes with subsequent statistical analysis was performed.

Results

Operative time (491 min vs. 281 min, p < 0.001) was longer for LPD than OPD. The rates of pancreatic fistula (11.7% vs. 0.0%, p < 0.001) and delayed gastric emptying (15.6% vs. 3.9%, p = 0.027) were higher for LPD than OPD respectively but overall morbidity was similar. Blood loss, mortality and post-pancreatectomy hemorrhage were also similar for both groups, but total costs ($60,245 vs. $50,900, p = 0.002) were significantly higher for LPD than OPD. Recurrence and overall survival were similar for the two groups.

Conclusion

In our experience, LPD does not offer any advantages over OPD for PDAC and is associated with a higher rate of complications and costs.

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来源期刊

Laparoscopic Endoscopic and Robotic Surgery minimally invasive surgery-

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development. Topics of interests include, but are not limited to: ▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.; ▪ Basic research in minimally invasive surgery; ▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging; ▪ Development of medical education in minimally invasive surgery.