Abstract: Objective: The aim of this study was to compare complications and oncologic outcomes of patients undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) at a single center. Methods: Distal pancreatectomies performed for pancreatic ductal adenocarcinoma during a 4-year period were included in this study. A retrospective analysis of a database of this cohort was conducted. Results: Twenty-two patients underwent LDP for pancreatic ductal adenocarcinoma, in comparison to seventy-six patients with comparable tumor characteristics treated by ODP. No patients with locally advanced lesions were included in this study. Comparing LDP group to ODP group, there were no significant differences in operation time (P=0.06) or blood loss (P=0.24). Complications (pancreatic fistula, P=0.62; intra-abdominal abscess, P=0.44; postpancreatectomy hemorrhage, P=0.34) were similar. There were no significant differences in the number of lymph nodes harvested (11.2±4.6 in LDP group vs. 14.4±5.5 in ODP group, P=0.44) nor the rate of patients with positive lymph nodes (36% in LDP group vs. 41% in ODP group, P=0.71). Incidence of positive margins was similar (9% in LDP group vs. 13% in ODP group, P=0.61). The mean overall survival time was (29.6±3.7) months for the LDP group and (27.6±2.1) months for ODP group. There was no difference in overall survival between the two groups (P=0.34). Conclusions: LDP is a safe and effective treatment for selected patients with pancreatic ductal adenocarcinoma. A slow-compression of pancreas tissue with the GIA stapler is effective in preventing postoperative pancreatic fistula. The oncologic outcome is comparable with the conventional open approach. Laparoscopic radical antegrade modular pancreatosplenectomy contributed to oncological clearance.

腹腔镜与开腹胰体尾切除术对胰腺导管腺癌的治疗经验

[1]Adsay, N.V., Basturk, O., Altinel, D., et al., 2009. The number of lymph nodes identified in a simple pancreatoduodenectomy specimen: comparison of conventional vs orange-peeling approach in pathologic assessment. Mod. Pathol., 22(1): 107-112.

[2]Baker, M.S., Bentrem, D.J., Ujiki, M.B., et al., 2009. A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery, 146(4):635-645.

[3]Bassi, C., Dervenis, C., Butturini, G., et al., 2005. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 138(1):8-13.

[4]Briggs, C.D., Mann, C.D., Irving, G.R., et al., 2009. Systematic review of minimally invasive pancreatic resection. J. Gastrointest. Surg., 13(6):1129-1137.

[5]de Rooij, T., Tol, J.A., van Eijck, C.H., et al., 2016. Outcomes of distal pancreatectomy for pancreatic ductal adenocarcinoma in the netherlands: a nationwide retrospective analysis. Ann. Surg. Oncol., 23(2):585-591.

[6]Fernández-Cruz, L., Cosa, R., Blanco, L., et al., 2007. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J. Gastrointest. Surg., 11(12):1607-1622.

[7]Jusoh, A.C., Ammori, B.J., 2012. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg. Endosc., 26(4):904-913.

[8]Khorana, A.A., Mangu, P.B., Berlin, J., et al., 2016. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J. Clin. Oncol., 34(21):2541-2556.

[9]Kooby, D.A., Gillespie, T., Bentrem, D., et al., 2008. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann. Surg., 248(3):438-446.

[10]Kooby, D.A., Hawkins, W.G., Schmidt, C.M., et al., 2010. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J. Am. Coll. Surg., 210(5):779-785.

[11]Nakamura, M., Ueda, J., Kohno, H., et al., 2011. Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy. Surg. Endosc., 25(3):867-871.

[12]Nigri, G.R., Rosman, A.S., Petrucciani, N., et al., 2011. Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg. Endosc., 25(5):1642-1651.

[13]Patterson, E.J., Gagner, M., Salky, B., et al., 2001. Laparoscopic pancreatic resection: single-institution experience of 19 patients. J. Am. Coll. Surg., 193(3):281-287.

[14]Pericleous, S., Middleton, N., McKay, S.C., et al., 2012. Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas, 41(7): 993-1000.

[15]Riviere, D., Gurusamy, K.S., Kooby, D.A., et al., 2016. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst. Rev., 4: CD011391.

[16]Sahakyan, M.A., Kazaryan, A.M., Rawashdeh, M., et al., 2016. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg. Endosc., 30(8):3409-3418.

[17]Shoup, M., Conlon, K.C., Klimstra, D., et al., 2003. Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J. Gastrointest. Surg., 7(8):946-952.

[18]Slidell, M.B., Chang, D.C., Cameron, J.L., et al., 2008. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann. Surg. Oncol., 15(1):165-174.

[19]Soh, Y.F., Kow, A.W., Wong, K.Y., et al., 2012. Perioperative outcomes of laparoscopic and open distal pancreatectomy: our institution’s 5-year experience. Asian J. Surg., 35(1): 29-36.

[20]Stauffer, J.A., Coppola, A., Mody, K., et al., 2016. Laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma. World J. Surg., 40(6):1477-1484.

[21]Strasberg, S.M., Linehan, D.C., Hawkins, W.G., 2007. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J. Am. Coll. Surg., 204(2):244-249.

[22]Sugiyama, M., Abe, N., Izumisato, Y., et al., 2001. Pancreatic transection using ultrasonic dissector in pancreato-duodenectomy. Am. J. Surg., 182(3):257-259.

[23]Teh, S.H., Tseng, D., Sheppard, B.C., 2007. Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J. Gastrointest. Surg., 11(9):1120-1125.

[24]Velanovich, V., 2006. Case-control comparison of laparoscopic versus open distal pancreatectomy. J. Gastrointest. Surg., 10(1):95-98.

[25]Wente, M.N., Veit, J.A., Bassi, C., et al., 2007. Postpancreatectomy hemorrhage (PPH)—An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 142(1):20-25.

[26]Yan, J.F., Kuang, T.T., Ji, D.Y., et al., 2015. Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 16(7):573-579.