A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

作     者：Abdul R Hakeem Caroline S Verbeke Alison Cairns Amer Aldouri Andrew M Smith Krishna V Menon 

作者机构：Department of HPB and Transplant Surgery St James's University Hospital NHS TrustLeeds Teaching Hospitals Beckett street Leeds LS9 7TF United Kingdom Division of Pathology Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden Department of HistopathologySt James's University Hospital NHS TrustLeeds Teaching Hospitals Beckett street Leeds LS9 7TF United Kingdom 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2014年第13卷第4期

页      面：435-441页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：the study abstract was presented as a poster at the international hepato- pancreato-biliary association (ihpba) meeting at paris  1-5 july 2012 and augis (association of upper gi surgeons of great britain and ireland) digestive disorders federation (ddf) at liverpool  17-20 june 2012 

主　　题：pancreaticoduodenectomy minimally invasive laparoscopic open oncological outcomes resection margins pathology 

摘      要：BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor ***： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs *** was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD ***： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.