Does tumor size influence the outcome of laparoscopic distal pancreatectomy?,HPB

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Does tumor size influence the outcome of laparoscopic distal pancreatectomy?
HPB ( IF 2.9 ) Pub Date : 2019-12-13 , DOI: 10.1016/j.hpb.2019.11.014
Airazat M Kazaryan ₁ , Ingeborg Solberg ₂ , Davit L Aghayan ₃ , Mushegh A Sahakyan ₄ , Ola Reiertsen ₅ , Vasiliy I Semikov ₆ , Alexander M Shulutko ₆ , Bjørn Edwin ₇

Affiliation

Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway; Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
Medical Faculty, The University of Oslo, Oslo, Norway.
Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia; Department of General and Laparoscopic Surgery, Central Clinical Military Hospital, Yerevan, Armenia.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia.
Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepatopancreatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.

Background

Laparoscopic distal pancreatectomy (LDP) is a safe procedure, but its role in resection of large pancreatic lesions has been questioned.

Methods

Patients who underwent LDP for pancreatic solitary tumors in 1997–2017 were included in this study. The patients were divided into three groups in accordance with tumor size: <3.5 cm (group I); from 3.5 cm to 7.0 cm (group II), and ≥7 cm (group III).

Results

218, 146 and 58 patients were identified in the groups I, II and III. Median tumor size in the groups I, II and III was 20, 47 and 81.5 mm (p < 0.001). Nine procedures (2.1%) were converted including 1(0.5%), 5(3.4%) and 3(5.2%) in the groups I, II and III (p = 0.036). Median operative time was longer in the group III compared with the groups I and II – 195 vs 158 and 159 min (p = 0.005). Median blood loss did not differ. Regression analysis revealed correlation between tumor size and operative time (R = 0.103; P = 0.035) and no correlation between tumor size and blood loss (R = 0.075; P = 0.125). Hospital stay was 5 days, similar in all groups.Postoperative morbidity was similar – 38.5, 32 and 34% in the group I, II and III.

Conclusion

LDP can be safely performed laparoscopically with outcomes similar to those for smaller tumors.

中文翻译：

肿瘤大小会影响腹腔镜胰腺远端切除术的结果吗？

背景

腹腔镜远端胰腺切除术 (LDP) 是一种安全的手术，但其在切除大面积胰腺病变中的作用受到质疑。

方法

本研究纳入了 1997-2017 年间因胰腺孤立性肿瘤接受 LDP 的患者。根据肿瘤大小将患者分为三组：<3.5 cm（I组）；从 3.5 厘米到 7.0 厘米（第 II 组）和≥7 厘米（第 III 组）。

结果

在 I、II 和 III 组中确定了 218、146 和 58 名患者。I、II 和 III 组的中位肿瘤大小为 20、47 和 81.5 mm (p < 0.001)。9 个程序 (2.1%) 被转换，包括 I、II 和 III 组中的 1 (0.5%)、5 (3.4%) 和 3 (5.2%) (p = 0.036)。与 I 组和 II 组相比，III 组的中位手术时间更长——分别为 195 分钟和 158 分钟和 159 分钟（p = 0.005）。中位失血量没有差异。回归分析显示肿瘤大小与手术时间之间存在相关性（R = 0.103；P = 0.035），而肿瘤大小与失血量之间没有相关性（R = 0.075；P = 0.125）。住院时间为 5 天，各组相似。术后发病率相似——I、II 和 III 组分别为 38.5%、32% 和 34%。