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A comparison of laparoscopic to open pancreaticoduodenectomy for pancreatic adenocarcinoma by propensity score matching analysis

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Laparoscopic, Endoscopic and Robotic Surgery 2024年第4期7卷 141-146页

作者： Jared mount brandon mount Katherine Poruk Mary Tice John A.Stauffer Department of Surgery Mayo ClinicJacksonvilleFLUSA Medical Education Heritage College of Osteopathic MedicineOhio UniversityAthensOHUSA Medical Education The University of ToledoCollege of Medicine and Life SciencesToledoOHUSA

Objective:In previous studies,laparoscopic pancreaticoduodenectomy(LPD)has demonstrated safety and potential benefits over open pancreaticoduodenectomy(OPD)for pancreatic adenocarcinoma(PDAC).After performing both LPD and OPD procedures interchangeably in routine practice for a decade,the outcomes of LPD versus OPD for PDAC were analyzed and compared at a single *** primary aim was to compare features of LPD and OPD in PDAC patients so that the suitable surgical approach may be chosen for each ***:From January 2010 through December 2020,all patients undergoing pancreaticoduodenectomy(PD)were identified,and information was collected *** a single institution,PD was performed on 589 patients,of whom 347 were OPD patients and 242 were LPD *** excluding those who underwent pancreatectomy for indications other than PDAC,total pancreatectomy,major vascular or concomitant organ resection,there were 237 patients(OPD¼157,LPD¼80).Then propensity score matching was completed to analyze 77 OPD patients versus 77 LPD patients to create a similar group of patients who underwent either LPD or OPD for PDAC.A comparison of perioperative data and 90-day outcomes with subsequent statistical analysis was ***:Operative time(491 min vs.281 min,p<0.001)was longer for LPD than *** rates of pancreatic fistula(11.7%vs.0.0%,p<0.001)and delayed gastric emptying(15.6%vs.3.9%,p¼0.027)were higher for LPD than OPD respectively but overall morbidity was *** loss,mortality and postpancreatectomy hemorrhage were also similar for both groups,but total costs($60,245 vs.$50,900,p¼0.002)were significantly higher for LPD than *** and overall survival were similar for the two ***:In our experience,LPD does not offer any advantages over OPD for PDAC and is associated with a higher rate of complications and costs.

关键词： Pancreaticoduodenectomy Whipple Laparoscopy Pancreatic fistula Pancreatic ductal adenocarcinoma

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Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer

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Journal of Cancer Therapy 2019年第4期10卷 269-289页

作者： Yakira David Lorenzo Ottaviano Jihye Park Sadat Iqbal Michelle Likhtshteyn Samir Kumar Helen Lyo Ayanna E. Lewis brandon E. Lung Jesse T. Frye Li Huang Ellen Li Jie Yang Laura Martello Shivakumar Vignesh Joshua D. Miller Michele Follen Evan B. Grossman Department of Medicine SUNY Downstate Medical Center Brooklyn NY USA Department of Gastroenterology Icahn School of Medicine at Mount Sinai New York City NY USA Department of Medicine Stony Brook University Stony Brook NY USA Department of Applied Mathematics and Statistics Stony Brook University Stony Brook NY USA Department of Family Population and Preventive Medicine Stony Brook University Stony Brook NY USA Department of Obstetrics and Gynecology NYC HNC/Kings County Brooklyn NY USA Department of Medicine Division of Gastroenterology NYC Health and Hospitals/Kings County Brooklyn NY USA

Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

关键词： Colorectal Cancer Screening Adenoma Quality

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