A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma: Is Laparoscopic Resection Appropriate?

作者：Kooby David A^*; Hawkins William G; Schmidt C Max; Weber Sharon M; Bentrem David J; Gillespie Theresa W; Sellers Johnita Byrd; Merchant Nipun B; Scoggins Charles R; Martin Robert C G III; Kim Hong Jin; Ahmad Syed; Cho Clifford S; Parikh Alexander A; Chu Carrie K; Hamilton Nicholas A; Doyle Courtney J; Pinchot Scott; Hayman Amanda; McClaine Rebecca; Nakeeb Attila; Staley Charles A; McMasters Kelly M; Lillemoe Keith D

来源：Journal of the American College of Surgeons, 2010, 210(5): 779-785.

DOI：10.1016/j.jamcollsurg.2009.12.033

BACKGROUND: As compared with open distal pancreatectomy (ODP), laparoscopic distal pancreatectomy (LDP) affords improved perioperative outcomes. The role of LDP for patients with pancreatic ductal adenocarcinoma (PDAC) is not defined.
STUDY DESIGN: Records from patients undergoing distal pancreatectomy (DP) for PDAC from 2000 to 2008 from 9 academic medical centers were reviewed. Short-term (node harvest and margin status) and long-term (survival) cancer outcomes were assessed. A 3:1 matched analysis was performed for ODP and LDP cases using age, American Society of Anesthesiologists (ASA) class, and tumor size.
RESULTS: There were 212 patients who underwent DP for PDAC; 23 (11%) of these were approached laparoscopically. For all 212 patients, 56 (26%) had positive margins. The mean number of nodes (+/- SD) examined was 12.6 +/- 8.4 and 114 patients (54%) had at least 1 positive node. Median overall survival was 16 months. In the matched analysis there were no significant differences in positive margin rates, number of nodes examined, number of patients with at least 1 positive node, or overall survival. Logistic regression for all 212 patients demonstrated that advanced age, larger tumors, positive margins, and node positive disease were independently associated with worse survival; however, method of resection (ODP vs. LDP) was not. Hospital stay was 2 days shorter in the matched comparison, which approached significance (LDP, 7.4 days vs. ODP, 9.4 days, p = 0.06).
CONCLUSIONS: LDP provides similar short- and long-term oncologic outcomes as compared with OD, with potentially shorter hospital stay. These results suggest that LDP is an acceptable approach for resection of PDAC of the left pancreas in selected patients. (J Am Coll Surg 2010;210: 779-787.

• 出版日期2010-5