Curative laparoscopic resection for pancreatic neoplasms:: A critical analysis from a single institution
Curative laparoscopic resection for pancreatic neoplasms:: A critical analysis from a single institution
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DOI：
10.1007/s11605-007-0266-0
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发表时间：
2007-12-01
影响因子：
3.2
通讯作者：
Navarro, Salvador
中科院分区：
文献类型：
--
作者：
Fernandez-Cruz, Laureano;Cosa, Rebeca;Navarro, Salvador
腹腔镜胰腺手术 (LPS) 已取得显着发展，但大部分知识涉及小型良性胰腺肿瘤。本研究旨在评估腹腔镜手术治疗胰腺良性、癌前和明显恶性病变的可行性、安全性和长期结果。这项研究是目前全球最大的单中心经验。 1998年4月至2007年4月连续123例患者接受腹腔镜胰腺手术，其中20例因急、慢性胰腺炎出现囊肿或假性囊肿，行腹腔镜胰腺引流术，排除分析。 103例患者根据术前诊断分为：I组，慢性胰腺炎炎性肿瘤（8例）；I组，慢性胰腺炎炎性肿瘤（8例）； II组，囊性胰腺肿瘤（29例）； III组，导管内乳头状粘液性肿瘤（10例）； IV组，胰腺神经内分泌肿瘤（NETs）（43例）；和V组导管腺癌（13例）。肿瘤大小中位数为 5.3 厘米。病理数据包括 R (0) 或 R (1) 切除（标本上的横断边缘有墨水）。使用统计分析比较围手术期数据、术后并发症和切除方式。通过肿瘤复发和患者生存来分析长期结果。整体转化率为7%。 82 名患者（79.6%）接受了腹腔镜远端胰腺切除术。 52 例（63.7%）患者接受腹腔镜保脾远端胰腺切除术（Lap SPDP），其中保留脾血管的占 22%，未保留脾血管的占 41.5%。 30 名患者（36.6%）接受腹腔镜整块脾胰切除术（Lap SxDP），20 名患者（19.4%）接受腹腔镜剜除术（Lap En）。没有死亡。 Lap SPDP、Lap SxDP 和 Lap En 后的总体并发症发生率分别为 25.2%、16.7% 和 40%。由于脾脏并发症的发生，未保留脾血管的Lap SPDP组的总体发病率显着高于保留脾血管的Lap SPDP组（p>0.05）（20.6%）。 Lap SPDP、Lap SxDP 和 Lap En 后，总体胰瘘发生率分别为 7.7%、10% 和 35%； Lap En 组的瘘管严重程度显着更高 (p > 0.05)。除导管腺癌组为 8 天外，所有组的平均住院时间均在 1 周以内。在该系列中，27 名患者（26.2%）患有恶性疾病。 90%的导管腺癌实现R（0）切除，100%的其他恶性肿瘤实现R（0）切除。导管腺癌患者的中位生存期为 14 个月。该系列证明 LPS 对于胰腺的良性和恶性病变是可行且安全的。
Laparoscopic pancreatic surgery (LPS) has seen significant development but much of the knowledge refers to small and benign pancreatic tumors. This study aims to evaluate the feasibility, safety, and long-term outcome of the laparoscopic approach in patients with benign, premalignant, and overt malignant lesions of the pancreas. This study, currently, is the largest single center experience worldwide. One hundred twenty-three consecutive patients underwent laparoscopic pancreatic surgery from April 1998 to April 2007, 20 patients with cysts or pseudocysts for acute and chronic pancreatitis, laparoscopic pancreatic drainage was performed, and were excluded from the analysis. The 103 patients were divided based on preoperative diagnosis: group I, inflammatory tumors for chronic pancreatitis (eight patients); group II, cystic pancreatic neoplasms (29 patients); group III, intraductal papillary mucinous neoplasms (10 patients); group IV, neuroendocrine pancreatic tumors (NETs) (43 patients); and group V ductal adenocarcinoma (13 patients). The median tumor size was 5.3 cm. Pathologic data include R (0) or R (1) resection (transection margins on the specimen were inked). Perioperative data, postoperative complications, and resection modalities were compared using statistical analysis. Long-term outcomes were analysed by tumor recurrence and patient survival. The overall conversion rate was 7%. Laparoscopic distal pancreatic resection was performed in 82 patients (79.6%). Laparoscopic spleen-preserving distal pancreatectomy (Lap SPDP) was performed in 52 patients (63.7%), but with splenic vessels preservation in 22% and without splenic vessels preservation in 41.5%. Laparoscopic en-bloc splenopancreatectomy (Lap SxDP) was performed in 30 patients (36.6%) and laparoscopic enucleation (Lap En) in 20 patients (19.4%). There was no mortality. The overall complication rate was 25.2, 16.7, and 40% after Lap SPDP, Lap SxDP, and Lap En, respectively. The overall morbidity rate was significantly higher (p > 0.05) in the group of Lap SPDP without splenic vessels preservation comparing with Lap SPDP with splenic vessels preservation because of the occurrence of splenic complications (20.6%). The overall pancreatic fistulas was 7.7, 10, and 35% after Lap SPDP, Lap SxDP, and Lap En, respectively; the severity of fistula was significantly higher in the Lap En group (p > 0.05). The mean hospital stay was within 1 week in all groups, except in the group of ductal adenocarcinoma, which is 8 days. In this series, 27 patients (26.2%) had malignant disease. R (0) resection was achieved in 90% of ductal adenocarcinoma and 100% for other malignant tumors. The median survival for ductal adenocarcinoma patients was 14 months. This series demonstrates that LPS is feasible and safe in benign-appearing and malignant lesions of the pancreas.