肠和胰胆亚型壶腹癌患者微创和开放性胰十二指肠切除术的结果：一项国际多中心队列研究。
Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients with Intestinal- and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study.
发表日期：2024 Sep 02
作者：
Bas A Uijterwijk, Alma Moekotte, Ugo Boggi, Michele Mazzola, Bas Groot Koerkamp, Raffaele Dalla Valle, Alessandro Mazzotta, Misha Luyer, Geert Kazemier, Benedetto Ielpo, Miguel Angel Suarez Muñoz, Louisa Bolm, Bergthor Björnsson, Patrick Pessaux, Jorg Kleeff, Giuseppe Kito Fusai, Ernesto Sparrelid, Alessandro Zerbi, Daniël H Lemmers, Adnan Alseidi, Miljana Vladimirov, Keith J Roberts, Roberto Salvia, Zahir Soonawalla, Dimitris Korkolis, Mario Serradilla-Martín, Vasileios K Mavroeidis, Stefan A W Bouwense, Marc G Besselink, Mohammed Abu Hilal,
来源：
ANNALS OF SURGERY
摘要：
比较不同亚型壶腹腺癌的微创和开腹胰十二指肠切除术。壶腹腺癌（AAC）由于缺乏血管受累以及胆汁和胰管扩张，被广泛认为是微创胰十二指肠切除术（MIPD）的最佳适应症。然而，由于缺乏大型研究，目前尚不清楚胰胆管 (AAC-PB) 和肠管 (AAC-IT) 亚型之间的 MIPD 治疗 AAC 的结果是否存在差异。这是一项国际队列研究，涵盖来自 12 个国家的 27 个中心。比较 AAC-IT 和 AAC-PB 患者的 MIPD 和开放性胰十二指肠切除术 (OPD) 的结果。主要终点是 R1 率、淋巴结产量和 5 年总生存率 (5yOS)。 总体而言，纳入了 1187 例 MIPD 后接受 AAC 的患者，其中 572 例接受 AAC-IT（62 例 MIPD，510 例 OPD），615 例接受 AAC -PB（41 MIPD 和 574 OPD）。对于 AAC-IT（3.4% vs 6.9%，P=0,425）和 AAC-PB（9.8% vs 14.9%，P=0,625），MIPD 和 OPD 之间的 R1 切除率没有显着差异。 AAC-IT 组中，与 OPD 组相比，MIPD 组切除了更多淋巴结（19 vs 16，P=0.007）。 MIPD 和 OPD 后，AAC-IT（56.8% vs 59.5%，P=0.827）和 AAC-PB（52.5% vs 44.4%，P=0.357）的 5y-OS 没有差异。MIPD 和 OPD 之间的手术并发症发生率AmpIT 和 AmpPB 之间的 OPD 没有差异。这项国际多中心研究发现，AAC-IT 和 AAC-PB 的 MIPD 和 OPD 之间的结果没有差异，MIPD 和 OPD 在 AAC 两种亚型的肿瘤切除、生存和手术结果方面表现出相似的结果。 .版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。
To compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma.Ampullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking.This is an international cohort study, encompassing 27 centers from 12 countries. Outcome of MIPD and open pancreatoduodenectomy (OPD) were compared in patients with AAC-IT and AAC-PB. Primary end points were R1 rate, lymph node yield, and 5-year overall survival (5yOS).Overall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD, 510 OPD) and 615 with AAC-PB (41 MIPD and 574 OPD). The rate of R1 resection was not significantly different between MIPD and OPD for both AAC-IT (3.4% vs 6.9%, P=0,425) and AAC-PB (9.8% vs 14.9%, P=0,625). AAC-IT, more lymph nodes were resected with MIPD group (19 vs 16, P=0.007), compared to OPD. The 5y-OS did not differ after MIPD and OPD for both AAC-IT (56.8% vs 59.5%, P=0.827 and AAC-PB (52.5% vs 44.4%, P=0.357). The rates of surgical complication between MIPD and OPD did not differ between AmpIT and AmpPB.This international multicenter study found no differences in outcomes between MIPD and OPD for AAC-IT and AAC-PB. MIPD and OPD demonstrated comparable outcomes in oncological resection, survival and surgical outcomes for both subtypes of AAC.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.