Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endo...Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.展开更多
BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the a...BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.展开更多
BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.So...BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects.Numerous recent review studies have compared multi-port laparoscopic DP(LDP)and multi-port robotic DP(RDP);most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation.However,there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP.AIM To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery.METHODS The PubMed medical database was searched for articles published between 2013 and 2022.The search terms were implemented using the following Boolean search algorithm:(“distal pancreatectomy”OR“left pancreatectomy”OR“peripheral pancreatic resection”)AND(“reduced-port”OR“single-site”OR“single-port”OR“dual-incision”OR“single-incision”)AND(“spleen-preserving”OR“spleen preservation”OR“splenic preservation”).A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP.RESULTS Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms.Two studies were added after manually searching the related papers.Finally,10 papers were selected after removing case reports(n=3),non-English language papers(n=1),technique papers(n=1),reviews(n=1),and animal studies(n=1).The common items were defined as items reported in more than five papers,and data on these common items were extracted from all papers.The ten studies included a total of 337 patients(females/males:231/106)who underwent DP.In total,166 patients(females/males,106/60)received multi-port LDP,126(females/males,90/36)received reduced-port LDP,and 45(females/males,35/10)received reduced-port RDP.CONCLUSION Reduced-port RDP leads to a lower intraoperative blood loss,a lower postoperative pancreatic fistula rate,and shorter hospital stay and follow-up duration,but has a lower spleen preservation rate.展开更多
文摘Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.
文摘BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.
基金Chung Shan Medical University,No.15I42440Feng Chia University/Chung Shan Medical University,No.FCU/CSMU104-001and Taiwan National Science and Technology Council,No.111-2314-B-035-001-MY3 and No.110-2221-E-035-016.
文摘BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects.Numerous recent review studies have compared multi-port laparoscopic DP(LDP)and multi-port robotic DP(RDP);most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation.However,there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP.AIM To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery.METHODS The PubMed medical database was searched for articles published between 2013 and 2022.The search terms were implemented using the following Boolean search algorithm:(“distal pancreatectomy”OR“left pancreatectomy”OR“peripheral pancreatic resection”)AND(“reduced-port”OR“single-site”OR“single-port”OR“dual-incision”OR“single-incision”)AND(“spleen-preserving”OR“spleen preservation”OR“splenic preservation”).A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP.RESULTS Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms.Two studies were added after manually searching the related papers.Finally,10 papers were selected after removing case reports(n=3),non-English language papers(n=1),technique papers(n=1),reviews(n=1),and animal studies(n=1).The common items were defined as items reported in more than five papers,and data on these common items were extracted from all papers.The ten studies included a total of 337 patients(females/males:231/106)who underwent DP.In total,166 patients(females/males,106/60)received multi-port LDP,126(females/males,90/36)received reduced-port LDP,and 45(females/males,35/10)received reduced-port RDP.CONCLUSION Reduced-port RDP leads to a lower intraoperative blood loss,a lower postoperative pancreatic fistula rate,and shorter hospital stay and follow-up duration,but has a lower spleen preservation rate.
