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Robotic versus laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: A propensity score-matched analysis

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Hepatobiliary & Pancreatic Diseases International 2023年第2期22卷 154-159页

作者： Dakyum Shin jaewoo kwon Jae Hoon Lee Seo Young Park Yejong Park Woohyung Lee Ki Byung Song Dae Wook Hwang Song Cheol Kim Division of Hepato-Biliary and Pancreatic Surgery Department of SurgeryAsan Medical CenterUniversity of Ulsan College of Medicine88 Olympic-ro 43-gilSongpa-guSeoul 05505Korea Department of Surgery Kangbuk Samsung HospitalSungkyunkwan University School of Medicine29 Saemunan-roJongno-guSeoul 03181Korea Department of Statistics and Data Science Korea National Open University86 Daehak-roJongno-guSeoul 03087Korea

Background: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy(RDP) for pancreatic ductal adenocarcinoma(PDAC). This study aimed to investigate the efficacy and feasibility of RDP for PDAC. Methods: Patients who underwent RDP or laparoscopic distal pancreatectomy(LDP) for PDAC between January 2015 and September 2020 were reviewed. Propensity score matching analyses were performed. Results: Of the 335 patients included in the study, 24 underwent RDP and 311 underwent LDP. A total of 21 RDP patients were matched 1:1 with LDP patients. RDP was associated with longer operative time(209.7 vs. 163.2 min;P = 0.003), lower open conversion rate(0% vs. 4.8%;P < 0.001), higher cost(15 722 vs. 12 699 dollars;P = 0.003), and a higher rate of achievement of an R0 resection margin(90.5% vs. 61.9%;P = 0.042). However, postoperative pancreatic fistula grade B or C showed no significant intergroup difference(9.5% vs. 9.5%). The median disease-free survival(34.5 vs. 17.3 months;P = 0.588) and overall survival(37.7 vs. 21.9 months;P = 0.171) were comparable between the groups. Conclusions: RDP is associated with longer operative time, a higher cost of surgery, and a higher likelihood of achieving R0 margins than LDP.

关键词： Minimally invasive surgery Robotic distal pancreatectomy Laparoscopic distal pancreatectomy Pancreatic ductal adenocarcinoma Propensity score matching

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Preoperative serum carbohydrate antigen 19-9 levels predict early recurrence after the resection of early-stage pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1423-1435页

作者： Sarang Hong Ki Byung Song Dae Wook Hwang Jae Hoon Lee Woohyung Lee Eunsung Jun jaewoo kwon Yejong Park Seo Young Park Naru Kim Dakyum Shin Hyeyeon Kim Minkyu Sung Yunbeom Ryu Song Cheol Kim Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryAsan Medical CenterSeoul 05505South Korea Department of Surgery Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoul 03181South Korea Department of Statistics and Data Science Korea National Open UniversitySeoul 03087South Korea Department of Surgery Uijeongbu St.Mary's HospitalCollege of MedicineGyeonggido 11765South Korea

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a serious disease with a poor prognosis.Only a minority of patients undergo surgery due to the advanced stage of the disease,and patients with early-stage disease,who are expected to have a better prognosis,often experience recurrence.Thus,it is important to identify the risk factors for early recurrence and to develop an adequate treatment plan.AIM To evaluate the predictive factors associated with the early recurrence of earlystage PDAC.METHODS This study enrolled 407 patients with stage I PDAC undergoing upfront surgical resection between January 2000 and April 2016.Early recurrence was defined as a diagnosis of recurrence within 6 mo of surgery.The optimal cutoff values were determined by receiver operating characteristic(ROC)analyses.Univariate and multivariate analyses were performed to identify the risk factors for early recurrence.RESULTS Of the 407 patients,98 patients(24.1%)experienced early disease recurrence:26(26.5%)local and 72(73.5%)distant sites.In total,253(62.2%)patients received adjuvant chemotherapy.On ROC curve analysis,the optimal cutoff values for early recurrence were 70 U/mL and 2.85 cm for carbohydrate antigen 19-9(CA 19-9)levels and tumor size,respectively.Of the 181 patients with CA 19-9 level>70 U/mL,59(32.6%)had early recurrence,compared to 39(17.4%)of 226 patients with CA 19-9 level≤70 U/mL(P70 U/mL(P=0.006),tumor size>2.85 cm(P=0.004),poor differentiation(P=0.008),and non-adjuvant chemotherapy(P=0.025)were significant risk factors for early recurrence in early-stage PDAC.CONCLUSION Elevated CA 19-9 level(cutoff value>70 U/mL)can be a reliable predictive factor for early recurrence in early-stage PDAC.As adjuvant chemotherapy can prevent early recurrence,it should be recommended for patients susceptible to early recurrence.

关键词： Pancreatic ductal adenocarcinoma Early recurrence Upfront surgery Carbohydrate antigen 19-9 Adjuvant chemotherapy

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