Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis
Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis
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DOI：
10.1007/s00464-017-5430-3
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发表时间：
2017-10-01
影响因子：
3.1
通讯作者：
Gayet, Brice
中科院分区：
文献类型：
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作者：
Conrad, Claudius;Basso, Valeria;Gayet, Brice
迄今为止，尚无研究报告接受腹腔镜胰十二指肠切除术 (LPD) 的患者与开放手术 (OPD) 相比的长期肿瘤学结果。本研究的目的是使用倾向评分加权模型评估接受 LPD 与 OPD 的腺癌患者的长期肿瘤学结果，以最大限度地减少选择偏差。2000 年 1 月至 2010 年 4 月期间在 Institut Mutualiste Montsouris 接受 PD 的所有患者均被纳入。使用多变量逻辑回归计算倾向评分，将术前协变量与手术方法相关联。进行逻辑回归，并构建术后结果的 Cox 比例风险模型，调整或不调整倾向评分权重。在 87 名接受 PD 的患者中，40 名接受 LPD，25 名因确诊腺癌接受 OPD。两组的术前协变量具有可比性。中位随访时间为 34.5 个月。在随访期间，16 名 (40%) LPD 和 7 名 (28%) OPD 患者发现转移。倾向评分调整后，中位总生存期 (OS) 分别为 35.5 个月和 29.6 个月。 LP 组和 OPD 组的 1 年、3 年和 5 年 OS 率分别为 80.5、49.2、39.7% 和 77.8、46.4、30%（P = 0.41、0.42、0.25）。中位无复发生存期 (RFS) 分别为 21.5 个月与 13.7 个月（LPD 与 OPD），LP 组和 OPD 组的 1 年、3 年和 5 年 RFS 率分别为 70.9、33.3、21.9% 和 62.3、37.9、25.7%（P = 0.27、0.37， 0.39）。由于 LPD 的早期采用，本研究首次报告了 LPD 的长期肿瘤学安全性：对于腺癌患者的长期结果，LPD 不劣于 OPD。
To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic pancreaticoduodenectomy (LPD) compared to open surgery (OPD). The aim of this study is assess long-term oncologic outcomes for patients with adenocarcinoma undergoing LPD versus OPD using propensity score weighting modeling to minimize selection bias.All patients undergoing PD at Institut Mutualiste Montsouris between January 2000 and April 2010 were included. Propensity scores were calculated using multivariate logistic regression, relating preoperative covariates to surgical approach. Logistic regression was performed, and Cox proportional hazards models for postoperative outcomes were constructed, with and without adjustment for propensity scores weights.Among 87 patients who underwent PD, 40 underwent LPD and 25 OPD for confirmed adenocarcinoma. Preoperative covariates across both groups were comparable. The median follow-up time was 34.5 months. During follow-up, metastasis was identified in 16 (40%) LPD and 7 (28%) OPD patients. After propensity score adjustment, the median overall survival (OS) was 35.5 versus 29.6 months, respectively. The 1-, 3-, and 5-year OS rates were 80.5, 49.2, 39.7% and 77.8, 46.4, 30% in the LP and OPD groups (P = 0.41, 0.42, 0.25), respectively. The median recurrence-free survival (RFS) was 21.5 versus 13.7 months (LPD vs. OPD), and the 1-, 3-, and 5-year RFS rates were 70.9, 33.3, 21.9% and 62.3, 37.9, 25.7% in the LP and OPD groups (P = 0.27, 0.37, 0.39), respectively.Due to the early adoption of LPD, this study is the first to report on long-term oncologic safety of LPD: LPD is non-inferior to OPD with respect to long-term outcomes for patients with adenocarcinoma.