Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

被引:5
作者
Balduzzi, A. [1 ,3 ]
van Hilst, J. [1 ]
Korrel, M. [1 ]
Lof, S. [1 ,2 ]
Al-Sarireh, B. [4 ]
Alseidi, A. [5 ]
Berrevoet, F. [6 ]
Bjornsson, B. [7 ]
van den Boezem, P. [8 ]
Boggi, U. [9 ]
Busch, O. R. [1 ]
Butturini, G. [10 ]
Casadei, R. [11 ]
van Dam, R. [12 ,37 ]
Dokmak, S. [13 ]
Edwin, B. [14 ,15 ]
Sahakyan, M. A. [14 ,15 ,36 ]
Ercolani, G. [16 ,17 ]
Fabre, J. M. [18 ]
Falconi, M. [19 ]
Forgione, A. [20 ]
Gayet, B. [21 ]
Gomez, D. [22 ]
Koerkamp, B. Groot [23 ]
Hackert, T. [24 ]
Keck, T. [25 ]
Khatkov, I [26 ]
Krautz, C. [27 ]
Marudanayagam, R. [28 ]
Menon, K. [29 ]
Pietrabissa, A. [30 ]
Poves, I [31 ]
Cunha, A. Sa [32 ]
Salvia, R. [3 ]
Sanchez-Cabus, S. [33 ]
Soonawalla, Z. [34 ]
Abu Hilal, M. [2 ,35 ,38 ]
Besselink, M. G. [1 ]
机构
[1] Univ Amsterdam, Amsterdam UMC, Canc Ctr Amsterdam, Dept Surg, NL-91100 AZ Amsterdam, Netherlands
[2] Univ Hosp Southampton NHS Fdn Trust, Dept Surg, Southampton, Hants, England
[3] Univ Verona Hosp Trust, Pancreas Inst, Gen & Pancreat Surg, Verona, Italy
[4] Morriston Hosp, Dept Surg, Swansea, W Glam, Wales
[5] Virginia Mason Med Ctr, Dept Surg, Seattle, WA 98101 USA
[6] Ghent Univ Hosp, Dept Gen & HPB Surg & Liver Transplantat, Ghent, Belgium
[7] Linkoping Univ, Dept Surg Linkoping, Dept Biomed & Clin Sci, Linkoping, Sweden
[8] Radboud Univ Nijmegen, Dept Surg, Med Ctr, Nijmegen, Netherlands
[9] Univ Pisa, Dept Surg, Pisa, Italy
[10] Pederzoli Hosp, Dept Surg, Peschiera, Italy
[11] St Orsola Marcello Malpighi Hosp, Dept Surg, Bologna, Italy
[12] Maastricht Univ, Dept Surg, Med Ctr, Maastricht, Netherlands
[13] Hosp Beaujon, Dept Surg, Clichy, France
[14] Oslo Univ Hosp, Dept Surg, Oslo, Norway
[15] Inst Clin Med, Oslo, Norway
[16] AUSL Romagna Forli, Morgagni Pierantoni Hosp, Dept Gen Surg & Oncol Surg, Forli, Italy
[17] Univ Bologna, Dept Med & Surg Sci DIMEC, Bologna, Italy
[18] Hop St Eloi, Dept Surg, Montpellier, France
[19] Univ Vita Salute, San Raffaele Hosp, San Raffaele Hosp Pancreas Translat & Clin Res Ct, Milan, Italy
[20] Osped Niguarda Ca Granda, Dept Surg, Milan, Italy
[21] Inst Mutualiste Montsouris, Dept Surg, Paris, France
[22] Nottingham Univ Hosp NHS Fdn Trust, Dept Surg, Nottingham, England
[23] Erasmus MC, Dept Surg, Rotterdam, Netherlands
[24] Heidelberg Univ Hosp, Dept Surg, Heidelberg, Germany
[25] Univ Hosp Schleswig Holstein UKSH, Dept Surg, Campus Lubeck, Lubeck, Germany
[26] Moscow Clin Sci Ctr, Dept Surg, Moscow, Russia
[27] Univ Hosp Erlangen, Dept Surg, Erlangen, Germany
[28] Univ Hosp Birmingham, Dept Surg, Birmingham, W Midlands, England
[29] Kings Coll Hosp NHS Fdn Trust, Dept Surg, London, England
[30] Univ Hosp Pavia, Dept Surg, Pavia, Italy
[31] Hosp del Mar, Dept Surg, Barcelona, Spain
[32] Hop Paul Brousse, Dept Surg, Villejuif, France
[33] Hosp Clin Barcelona, Dept Surg, Barcelona, Spain
[34] Oxford Univ Hosp NHS Fdn Trust, Dept Surg, Oxford, England
[35] Ist Osped Fdn Poliambulanza, Dept Gen Surg, Brescia, Italy
[36] Yerevan State Med Univ M Heratsi, Dept Surg N1, Yerevan, Armenia
[37] Univ Hosp RWTH Aachen, Dept Surg, Aachen, Germany
[38] Southampton Univ, HPB & Minimally Invas Surg, Southampton, Hants, England
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2021年 / 35卷 / 12期
关键词
Left pancreatectomy; Extended resection; ERLP; PDAC; DISTAL PANCREATECTOMY; SURGICAL COMPLICATIONS; SURGERY; PANCREATOSPLENECTOMY; CLASSIFICATION; DEFINITION; CANCER; COHORT;
D O I
10.1007/s00464-020-08206-y
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade >= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
引用
收藏
页码:6949 / 6959
页数:11
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