Preliminary observation on the short-term efficacy of laparoscopic and open pancreaticoduodenectomy in the treatment of periampullary malignant tumors
10.3760/cma.j.cn112139-20200408-00287
- VernacularTitle:腹腔镜手术与开腹手术治疗壶腹周围恶性肿瘤近期效果的初步观察
- Author:
Junfeng CHENG
1
;
Xuemin LI
;
Xiaokang WU
;
Hui YUAN
;
Shi′an YU
Author Information
1. 浙江大学医学院附属金华医院肝胆胰外科一区 321000
- Keywords:
Pancreaticoduodenectomy;
Laparoscopy;
Periampullary carcinoma;
Pancreatic neoplasms;
Treatment outcome;
Propensity score matching analysis
- From:
Chinese Journal of Surgery
2020;58(12):918-923
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.
