Comparison of short‑ and long‑term outcomes between laparoscopic and open pancreaticoduodenectomy in overweight patients: a propensity score‑matched study.
Shuai Xu, Yinlong Xu, Shulin Wang, Qingsen Chu, Huating Zhang, Wei Gong, Yantian Xu, Jun Liu
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引用次数: 0
Abstract
Background: Overweight is thought to affect the outcome of minimally invasive surgery. There is still a lack of controlled studies of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) in overweight patients. This study was designed to compare short-term and long-term outcomes in overweight patients treated with LPD and OPD.
Methods: Clinical and follow-up data on overweight patients who received LPD or OPD at Shandong Provincial Hospital from January 2015 to December 2022 were analyzed retrospectively. The bias between groups were balanced by 1:1 propensity score matching (PSM). Kaplan-Meier survival curves described long-term survival outcomes in overweight pancreatic ductal adenocarcinoma (PDAC) patients.
Results: A total of 502 overweight patients were enrolled in the study. There were 276 patients in the LPD group and 226 in the OPD group. After matching, 196 patients were enrolled in each group. Compared with the OPD group, the LPD group had fewer estimated blood loss (EBL) (140 vs. 200 mL, P < 0.001), more lymph node dissection (14 vs. 12, P = 0.010), and shorter postoperative length of stay (LOS) (13 vs. 16 days, P < 0.001). There were no significant differences in severe complications, 90-day readmission and mortality rates (all P > 0.05). The subgroup analysis of obese patients also showed that the LPD group had fewer intraoperative EBL, more lymph node dissection, and shorter LOS. The survival analysis showed that overweight patients with PDAC who underwent LPD or OPD had similar overall survival (OS) (23.8 vs.25.7 months, P = 0.963) after PSM.
Conclusion: It is safe and feasible for overweight patients undergoing LPD to have less EBL, more lymph node harvesting, and a shorter LOS. There was no statistically significant difference in long-term survival outcomes among overweight PDAC patients between the two approaches.
背景：超重被认为会影响微创手术的结果。在超重患者中，腹腔镜胰十二指肠切除术（LPD）与开放式胰十二指肠切除术（OPD）的对照研究仍然缺乏。本研究旨在比较超重患者接受LPD和OPD治疗的短期和长期结果。方法：回顾性分析2015年1月至2022年12月山东省立医院接受LPD或OPD治疗的超重患者的临床及随访资料。组间偏倚采用1:1倾向评分匹配（PSM）进行平衡。Kaplan-Meier生存曲线描述了超重胰腺导管腺癌（PDAC）患者的长期生存结果。结果：共有502名超重患者入组研究。LPD组276例，OPD组226例。配对后，每组入组196例。与OPD组相比，LPD组的估计失血量（EBL）更少（140 mL vs 200 mL, p0.05）。肥胖患者的亚组分析也显示，LPD组术中EBL较少，淋巴结清扫较多，LOS较短。生存分析显示，超重的PDAC患者接受LPD或OPD后，PSM后的总生存期（OS）相似（23.8个月vs.25.7个月，P = 0.963）。结论：超重患者行LPD术后EBL减少、淋巴结清扫增多、LOS缩短是安全可行的。两种方法对超重PDAC患者的长期生存结果无统计学差异。
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
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