scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Tumour Size ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is a leading causes of cancer mortality worldwide. Currently, laparoscopic pancreatic resection (LPR) is extensively applied to treat benign and low-grade diseases related to the pancreas. The viability and safety of LPR for PDAC needs to be understood better. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are the two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD). Methods We assessed the data of patients who underwent distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for PDAC between January 2004 and February 2020 at our hospital. A one-to-one PSM was applied to prevent selection bias by accounting for factors such as age, sex, body mass index, and tumour size. The DP group included 86 LDP patients and 86 ODP patients, whereas the PD group included 101 LPD patients and 101 OPD patients. Baseline characteristics, intraoperative effects, postoperative recovery, and survival outcomes were compared. Results Compared to ODP, LDP was associated with shorter operative time, lesser blood loss, and similar overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. The short-term surgical advantage of LPD is not as apparent as that of LDP due to conversions. Compared with OPD, LPD was associated with longer operative time, lesser blood loss, and similar overall morbidity. For oncological and survival outcomes, there were no significant differences in tumour size, R0 resection rate, and tumour stage in both the DP and PD subgroups. However, laparoscopic procedures appear to have an advantage over open surgery in terms of retrieved lymph nodes (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). These two groups did not show a significant difference in the pattern of recurrence and overall survival rate. Conclusions Laparoscopic DP and PD are feasible and oncologically safe procedures for PDAC, with similar postoperative outcomes and long-term survival among patients who underwent open surgery.

scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Tumour Size ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is a leading causes of cancer mortality worldwide. Currently, laparoscopic pancreatic resection (LPR) is extensively applied to treat benign and low-grade diseases related to the pancreas. The viability and safety of LPR for PDAC needs to be understood better. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are the two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD). Methods: We assessed the data of patients who underwent distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for PDAC between January 2004 and February 2020 at our hospital. A one-to-one PSM was applied to prevent selection bias by accounting for factors such as age, sex, body mass index, and tumour size. The DP group included 86 LDP patients and 86 ODP patients, whereas the PD group included 101 LPD patients and 101 OPD patients. Baseline characteristics, intraoperative effects, postoperative recovery, and survival outcomes were compared. Results: Compared to ODP, LDP was associated with shorter operative time, lesser blood loss, and similar overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. The short-term surgical advantage of LPD is not as apparent as that of LDP due to conversions. Compared with OPD, LPD was associated with longer operative time, lesser blood loss, and similar overall morbidity. For oncological and survival outcomes, there were no significant differences in tumour size, R0 resection rate, and tumour stage in both the DP and PD subgroups. However, laparoscopic procedures appear to have an advantage over open surgery in terms of retrieved lymph nodes. These two groups did not show a significant difference in the pattern of recurrence and overall survival rate. Conclusions: Laparoscopic DP and PD are feasible and oncologically safe procedures for PDAC, with similar postoperative outcomes and long-term survival among patients who underwent open surgery.

scholarly journals Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Chao-jie Huang ◽  
Qi-long Chen ◽  
Ren-chao Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Open Surgery ◽  
Operative Time ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes ◽  
Low Grade

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most leading causes of cancer mortality worldwide. Laparoscopic pancreatic resection (LPR) has been widely used in the treatment of benign and low-grade pancreatic diseases. It is necessary to expand the current knowledge on the feasibility and safety of LPR for PDAC. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses, aiming to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).Methods: Data of patients who underwent DP and PD for PDAC from January 2004 to February 2020 in our hospital were obtained. Baseline characteristics, intraoperative effect, postoperative recovery, and survival outcomes were compared. One-to-one PSM was used to minimize selection biases by balancing factors including age, sex, BMI, and tumor size.Results: Patient demographics were well matched after PSM. The DP subgroup included 86 LDP patients and 86 ODP patients, whereas the PD subgroup included 101 LPD patients and 101 OPD patients. Compared to ODP, LDP was associated with shorter operative time, less blood loss, and comparable overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. LPD was associated with longer operative time, less blood loss, and comparable overall morbidity. For oncological and survival outcomes, there were no significant differences in tumor sizes, R0 resection rate and tumor stage in both DP and PD subgroup. However, laparoscopic procedures seems to have an advantage over open surgery in terms of retrieved lymph node (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). There was no statistical significance between both groups in recurrence pattern, and 3-year recurrence-free and overall survival were comparable between groups.Conclusions: Both LDP and LPD are feasible and oncologically safe procedures for PDAC. Postoperative outcomes and long-term survival of LDP and LPD are not inferior or superior to open surgery. However, the short-term surgical advantage of LPD is not as obvious as LDP mainly due to the conversions. Our findings should be further evaluated by multicenter or randomized controlled trials.

Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11534-11534
Author(s):  
Wenjun Xiong ◽  
Tao Chen ◽  
Xingyu Feng ◽  
Yuting Xu ◽  
Jin Wan ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Propensity Score ◽  
Blood Loss ◽  
Gastrointestinal Stromal Tumor ◽  
Propensity Score Matching ◽  
Open Surgery ◽  
Esophagogastric Junction ◽  
Operative Time ◽  
Liquid Intake

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.

scholarly journals Total laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis with meta-analysis

2020 ◽  
Author(s):  
Ke Chen ◽  
Yu Pan ◽  
Yi-ping Mou ◽  
Chao-jie Huang ◽  
Jia-fei Yan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Propensity Score Matching ◽  
Meta Analysis ◽  
Ductal Adenocarcinoma ◽  
Survival Outcomes ◽  
Low Grade ◽  
Open Pancreaticoduodenectomy

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer mortality worldwide. Total laparoscopic pancreaticoduodenectomy (TLPD) have been used in the treatment of benign and low-grade diseases on the pancreatic head. It is necessary to expand the current knowledge on the feasibility and safety of TLPD for PDAC treatment. We aimed to assess the surgical and oncological outcomes of TLPD for patients with PDAC by comparing them with open pancreaticoduodenectomy (OPD). Methods Data regarding patients who underwent pancreaticoduodenectomy for PDAC treatment from January 2013 to January 2019 in our hospital were obtained. Baseline characteristics, intraoperative effects, postoperative recoveries, and survival outcomes were compared. To overcome selection bias, we performed a 1:1 match using propensity score matching (PSM) between TLPD and OPD. We also conducted a systematic review and meta-analysis. Results The original cohort included 276 patients (TLPD; 98 patients, OPD; 178 patients). After PSM, there were 89 patients in each group and the patient demographics were well matched. Of the 98 patients who underwent TLPD, 8 (8.2%) required conversions to laparotomies. Compared to OPD, TLPD could be performed with longer operative times, had less blood loss, and had lower overall morbidities. Regarding oncological and survival outcomes, there were no significant differences in tumor size, R0 resection rates and tumor stages between groups. However, TLPD had an advantage over OPD in terms of retrieved lymph nodes (21.9 ± 6.6 vs. 18.9 ± 5.4, p < 0.01). There were no statistically significant differences between the groups in recurrence patterns, and the 3-year recurrence-free and overall survival rates were comparable between the two groups. Meta-analysis further confirmed that the TLPD were associated with longer operative times, less blood loss, shorter hospitalizations, lower morbidities, and a greater number of retrieved lymph nodes. Conclusions TLPD are feasible and oncologically safe procedures for PDAC treatments. Postoperative outcomes and long-term survival after TLPD are superior, or not inferior, to OPD, and could be a promising alternative to open surgery for PDAC treatments. Our findings should be further evaluated by multicenter or randomized controlled trials.

scholarly journals Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) with Preservation of Splenic Vessels: An Inferior-Posterior Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yong Fei Hua ◽  
Dipesh Kumar Yadav ◽  
Xueli Bai ◽  
Tingbo Liang
Keyword(s):  
Blood Loss ◽  
Distal Pancreatectomy ◽  
Splenic Artery ◽  
Posterior Approach ◽  
Operative Time ◽  
The Other ◽  
Intraoperative Blood Loss ◽  
Spleen Preserving ◽  
Splenic Vessels ◽  
Approach Group

Objective. To summarize the operation experience of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with preservation of splenic vessels by an inferior-posterior dissection of the pancreatic body and evaluate its feasibility. Methods. Patients undergoing LSPDS at Ningbo Li Huili Hospital and Ningbo Li Huili Eastern Hospital from January 2014 to April 2017 were recruited in this study and were analyzed retrospectively. They were divided into two groups based on the surgical approach: the inferior-posterior approach group and the other approach group. We sought to compare outcomes of the two groups. Results. The LSPDP procedure was completed successfully in 49 cases, and 48 patients had their splenic artery and vein preserved, including 26 cases in the inferior-posterior approach group and 22 cases in the other approach group. There were no significant differences between the two groups with respect to age (p=0.18), sex (p=0.56), preoperative diabetes (p=1.00), ASA grading (p=1.00), tumor size (p=0.91), intraoperative blood loss (t=−0.01, p=0.99), hospital stay (t=−0.02, p=0.98), and pancreatic fistula rates (p=1.00). Patients undergoing LSPDP by the inferior-posterior approach had a shorter operative time (t=−4.13, p<0.001) than the other approach group. Conclusions. LSPDS by the inferior-posterior approach associated with shorter operative time is safe and feasible.

scholarly journals Reducing Morbidity in Urgent Gastroenterologic Surgery; Propensity Score Analysis Using Triclosan-Coated Polydioxanone Sutures

2017 ◽  
Vol 102 (1-2) ◽  
pp. 58-63
Author(s):  
Shinsuke Takeno ◽  
Kanefumi Yamashita ◽  
Tomoaki Noritomi ◽  
Seichiro Hoshino ◽  
Yasushi Yamauchi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Propensity Score Matching Analysis ◽  
Abdominal Closure

Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P = 0.043); wound classification (P = 0.0005); peritonitis (P = 0.019); prolonged operation time (P = 0.0001); increased blood loss (P = 0.019); transfusion (P = 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P = 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P = 0.20), but it tended to be associated with a shorter hospital stay (P = 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.

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