Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center
Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center
复制标题
DOI：
10.1007/s00464-019-06913-9
复制
发表时间：
2020-03-01
影响因子：
3.1
通讯作者：
Park, Guisuk
中科院分区：
文献类型：
--
作者：
Song, Ki Byung;Kim, Song Cheol;Park, Guisuk
背景：在选定的患者中，腹腔镜胰腺十二指肠切除术(LPD)是一种可行的选择。然而，它的使用还没有普及，因为它耗时、对体力的要求和技术上的挑战。分享大容量中心的经验以了解其使用情况可能是至关重要的。方法我们回顾了2007年1月至2017年12月在同一机构连续接受LPD的500例患者的数据。结果本组病例中女性272例，男性228例，平均年龄57.1岁。LPD最常见的指征是导管内乳头状瘤(n=104，20.8%)。并发症发生率(Clavien-Dindo分级III~V级)分别为37.2%和4.8%。临床相关(B/C级)胰瘘54例(10.8%)。有3例(0.6%)在90天内死亡。最常见的晚期并发症是胆肠狭窄(25，5%)。230名患者被诊断为壶腹周围癌。胰腺癌、胆总管癌、壶腹癌和十二指肠癌的5年总生存率分别为37.4%、63.2%、78%和88.9%。我们分析了第一代和第二代外科医生的学习曲线。经风险调整的累积和分析显示，LPD与第一代外科医生的学习曲线为55例，与第二代外科医生的学习能力较早。结论LPD有可能成为壶腹周围肿瘤行开腹胰十二指肠切除术的一种替代手术，疗效满意。我们可以通过有组织的培训、严密的监督和训练有素的运营团队来减少陡峭的学习曲线。在克服学习曲线后，LPD的围手术期和肿瘤学结果将得到优化。
Background Laparoscopic pancreaticoduodenectomy (LPD) is a feasible option in selected patients. However, its use has not yet been generalized since it is time-consuming, physically demanding, and technically challenging. It might be essential to share the experience of high-volume centers to understand its use. Methods We retrospectively reviewed the data of 500 consecutive patients who underwent LPD at a single institution between January 2007 and December 2017. Results The patients included 272 women and 228 men (mean age, 57.1 years). The most common indication for LPD was intraductal papillary neoplasm (n = 104, 20.8%). Overall and major (Clavien-Dindo grades III-V) complication rates were 37.2% and 4.8%, respectively. Fifty-four patients (10.8%) had clinically relevant (grade B/C) pancreatic fistulas. There were 3 (0.6%) 90-day mortalities. The most common late complication was bilioenteric stricture (25, 5%). Two hundred thirty patients were diagnosed with periampullary cancer. The 5-year overall survival rates of pancreatic cancer, common bile duct cancer, ampulla of Vater cancer, and duodenal cancer were 37.4, 63.2, 78, and 88.9%, respectively. We analyzed learning curves of first-generation and second-generation surgeons. A risk-adjusted cumulative sum analysis demonstrated a learning curve of 55 cases for LPD with the first-generation surgeon and earlier competency with the second-generation surgeon. Conclusions LPD has the potential to become an alternative surgery to open pancreaticoduodenectomy for periampullary tumors with acceptable outcomes. We could reduce the steep learning curve with structured training, close supervision, and well-trained operation teams. Perioperative and oncologic outcomes of LPD will be optimized after overcoming the learning curve.