Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)
Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)
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DOI：
10.1097/sla.0000000000002561
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发表时间：
2019-01-01
影响因子：
9
通讯作者：
Abu Hilal, Mohammed
中科院分区：
文献类型：
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作者：
van Hilst, Jony;de Rooij, Thijs;Abu Hilal, Mohammed
目的：本研究的目的是比较胰腺导管腺癌（PDAC.Background）患者行微创胰尾切除术（MIDP）和开放式胰尾切除术（ODP）后的肿瘤学结局：队列研究表明MIDP的短期结局优于ODP。然而，最近的国际调查显示，外科医生对MIDP PDAC.Methods的肿瘤学结局表示担忧：这是一项泛欧倾向评分匹配研究，包括2007年1月1日至2015年7月1日期间接受MIDP（腹腔镜或机器人辅助）或ODP PDAC的患者。MIDP患者与ODP患者以1：1的比例匹配。主要结果是根治性（R 0）切除术，淋巴结回收，和survival.Results：在总数，1212例患者包括来自34个中心在11个国家。在356例（29%）MIDP患者中，340例匹配。匹配后，MIDP转换率为19%（n = 62）。MIDP后的中位失血量[200 mL（60-400）vs 300 mL（150-500），P = 0.001]和住院时间[8（6-12）vs 9（7-14）天，P < 0.001]较低。MIDP和ODP的Clavien-Dindo分级≥ 3级并发症（18% vs 21%，P = 0.431）和90天死亡率（2% vs 3%，P > 0.99）分别相当。MIDP后R 0切除率较高（67% vs 58%，P = 0.019），而Gerota筋膜切除率（31% vs 60%，P < 0.001）和淋巴结清扫率[14（8-22）vs 22（14-31），P < 0.001]较低。中位总生存期为28 [95%置信区间（CI），22-34] vs 31（95% CI，26-36）个月（P = 0.929）。MIDP和ODP治疗PDAC后的生存率相当，但R 0切除率、Gerota筋膜切除率、和淋巴结切除加强了随机试验的必要性，以确认MIDP的肿瘤安全性。
Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC).Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC.Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival.Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade >= 3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929).Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.