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Minimal invasive surgery of pancreatic cancer at the Department of Surgery of Masaryk university hospital Brno, Czech Republic

Česká verzia

Authors: J. Hlavsa 1;  T. Pavlík 2;  D. Marek 1;  A. Šikyňová 2;  Viktor Procházka 1 ;  P. Moravčík 1;  M. Eid 3 ;  L. Ostřížková 3;  J. Vlažný 4;  K. Múčková 4;  M. Dastych 5;  R. Kroupa 5;  J. Pospíšil 1;  D. Ivanecká 1;  A. Kitzlerová 6;  Z. Kala 1
Authors place of work: Chirurgická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Česká republika 1;  Institut biostatistiky a analýz, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Česká republika 2;  Interní hematoonkologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Česká, republika 3;  Ústav patologie, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Česká republika 4;  Interní gastro-enterologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Česká, republika 5;  Lékařská fakulta Masarykovy univerzity 6
Published in the journal: Rozhl. Chir., 2024, roč. 103, č. 4, s. 122-131.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2024.103.4.122–131

Summary

Introduction: The aim of the study was to perform a retrospective analysis of patients who had undergone laparoscopic resection for pancreatic cancer (PC) at the Department of Surgery of the Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic from 2010 to 2023.

Methods: Forty-six patients with laparoscopic (n=19) or open (n=27) distal pancreatectomy (DP) for PC were included. Both groups were statistically evaluated and compared in the following parameters: clinical stage, tumor grade, nodes examined by the pathologist, blood loss, duration of surgery, three-month morbidity and mortality, length of ICU stay, overall length of hospital stay, readmission rate and overall survival.

Results: There were more T3 tumors in the open DP group (81.5% vs 57.9%, p=0.035). The rate of dedifferentiated (G3) tumors was higher in the open DP group (18.5% vs 5.3%, p=0.354). The mean number of nodes examined by the pathologist was equal in both groups (open DP 15.1 (min– max, 3–39) vs lapDP 15.6 (min–max, 5−39). Laparotomy was associated with a higher mean blood loss (531 ml vs 198 ml, p=0.002). However, it was shorter on average (190 minutes vs 216 minutes, p=0.006). Clinically relevant complications (Dindo III and higher) and POPF (types B and C) were observed in 10/46 (21.7%) and 14/46 (30.5%) cases without any statistically significant difference between both groups (p=0.489 and p=0.241, respectively). The median ICU stay was similar for lapDP and open DP (median: 5.0 days vs 6.0 days, p=0.396). Overall length of hospital stay was identical in both groups (median: lapDP 12.0 days vs open DP 12 days, p=0.920). The three-month readmission rate was 5/46 (10.9%). One-, 2-, 3and 5-year overall survival probability after laparoscopic and open DP was 76.9% (95% CI 59.4−99.7%), 61.5% (95% CI 41,1−92.2%), 41.0% (95% CI 20,5−82.2%) and 20.5% (95% CI 6.2−68.2%), and 73.4% (95% CI 58.3−92.4%), 33.1% (95% CI 18,9−57.9%), 20.7% (95% CI 9.5−44.9%) and 20.7% (95% CI 9.5−44.9%), respectively. No statistically significant difference was observed between both groups (p=0.484).

Conclusion: When comparing lapDP and open DP performed for pancreatic cancer, our experience confirmed that lapDP was particularly suitable for patients with smaller tumors located further from the porto-mesenteric axis. The laparoscopic approach was associated with lower blood loss, reduced length of ICU stay, comparable morbidity and overall survival. The relatively long length of hospital stays, surprisingly identical in both groups, prompted us to implement the ERAS (Enhanced Recovery After Surgery) protocol in this surgical field.

Keywords:

surgery – Pancreatic cancer – Robotics – laparoscopy

Zdroje
  1. Van Hilst J, De Rooij T, Klompmaker S, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): A pan-European propensity score matched study. Ann Surg. 2019;269(1):10−17. doi:10.1097/ SLA.0000000000002561.
  2. Cuschieri A. Value of laparoscopy in the diagnosis and management of pancreatic carcinoma. Gut 1978;19:672–677. doi: 10.1136/gut.19.7.672.
  3. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–410. doi: 10.1007/ BF00642443.
  4. Cuschieri A. Laparoscopic pancreatic resections. Semin Laparosc Surg. 1996;3:15–20. doi: 10.1053/SLAS00300015.
  5. Fried M, Peskova M, Kasalicky M, et al. Advantages of laparoscopic surgery in advanced pancreatic tumors. Acta Univ Palacki Olomuc Fac Med. 2000;143:82.
  6. Šváb J, Škrha J, Gürlich R, et al. Laparoskopická diagnostika a léčba organického hyperinzulinismu – naše první zkušenosti. Rozhl Chir. 2005;84:70–74.
  7. Gürlich R, Sixta B, Oliverius M, et al. Laparoskopická distální resekce pankreatu. Rozhl Chir. 2005;84:463–465.
  8. Kunovský L, Kala Z, Procházka V, et al. Laparoskopická hemipankreatoduodenektomie u ampulárního adenokarcinomu – kazuistika. Gastroent Hepatol. 2018;72(5):401–407. doi:10.14735/amgh2018401.
  9. Jaroščiaková S, Tvrdoň J, Hladík P, et al. Robotická distální pankreatektomie − první zkušenosti. Rozhl Chir. 2023 Spring; 102(3):125−129. doi: 10.33699/ PIS.2023.102.3.125-129.
  10. Loveček M, Skalický P, Klos D, et al. Robotická chirurgie slinivky břišní v pankreatochirurgickém high-volume centru – první zkušenosti. Gastroent Hepatol. 2023;77(4):295–301. doi:10.48095/ccgh 2023295.14.
  11. M Loveček, P Záruba, J Ulrych, et al. Minimally-invasive pancreatic surgery in high volume centers in the Czech Republic − current status and possible implementations. Rozhl Chir. 2024;102(11):416−421. doi: 10.33699/PIS.2023.102.11.416-421.
  12. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery 2003 May; 133(5):521-7.  doi:  10.1067/msy.2003.146.
  13. Moravčík P, Kala Z, Hlavsa J, et al. Prevence vzniku pankreatické píštěle u laparoskopických levostranných pankreatektomií. Gastroent Hepatol. 2022;76(3):212–217. doi: 10.48095/ccgh2022212.
  14. Lee SH, Hwang HK, Kang CM, et al. The Yonsei criteria as a clinically detectable parameter for excellent prognosis in resected left-sided pancreatic cancer: outcomes of a propensity score-matched analysis. Surg Endosc. 2017;31:4656– 4664. doi.org/10.1007/s00464-017-5529-6.
  15. Hilst J, de Rooij T, Abu Hilal M, et al. Worldwide survey on opinions and use of minimally invasive pancreatic resection. HPB 2017;19(3):190e204. 2010;1(2):97e111. doi: 10.1016/j.hpb.2017.01.011.
  16. Cassinotto C, Cortade J, Belleannee G, et al. An evaluation of the accuracy of CT when determining resectability of pancreatic head adenocarcinoma after neoadjuvant treatment. Eur J Radiol. 2013;82:589−593. doi: 10.1016/j. ejrad.2012.12.002.
  17. Tol J, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: A consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2016;156(3)P591−600. doi: 10.1016/j.surg.2014.06.016.
  18. Granieri S, Kersik A, Bonomi A, et al. The role of non-peripancreatic lymph nodes in the survival of patients suffering from pancreatic cancer of the body and tail: A systematic review and meta-analysis of high-quality studies. Cancers (Basel) 2023 Apr;15(8):2322. doi: 10.3390/cancers15082322.
  19. Blomhoff Holm M, Verbeke CS. Prognostic impact of resection margin status on distal pancreatectomy for ductal adenocarcinoma. Curr Oncol. 2022 Sep;29 (9): 6551–6563. doi: 10.3390/curroncol29090515.
  20. Korrel M, Lof S, van Hilst J, et al. Predictors for survival in an international cohort of patients undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2021;28:1079–1087. doi: 10.1245/s10434-020-08658-5.
  21. Sahakyan MA, Verbeke CS, Tholfsen T, et al. Prognostic impact of resection margin status in distal pancreatectomy for ductal adenocarcinoma. Ann Surg Oncol. 2022;29:366–375. doi: 10.1245/s10434-021-10464-6.
  22. van Hilst J, Korrel M, de Rooij T, et al. DIPLOMA study group, oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis. Eur J Surg Oncol. 2019 May;45(5):719−727. doi: 10.1016/j. ejso.2018.12.003.
  23. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017;161(3):584–591. doi: 10.1016/j.surg. 2016.11.014.
  24. He C, Zhang Y, Li L, et al. Risk factor analysis and prediction of postoperative clinically relevant pancreatic fistula after distal pancreatectomy. BMC Surg. 2023;23(5). doi:10.1186/s12893-023-01907-w.
  1. Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2025;92:539−546. doi: 10.1002/bjs.5000.
  2. van der Heijde N, Lof S, Busch OR, et al. Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy. Pancreas 2022;171(6):1658−1664-doi:10.1016/j. surg.2021.11.009.
  3. Sugimoto M, Kendrick ML, Farnell MB, et al. Relationship between pancreatic thickness and staple height is relevant to the occurrence of pancreatic fistula after distal pancreatectomy. HPB (Oxford) 2020;22:398–404. doi: 10.1016/j. hpb.2019.07.010.
  4. Asbun HJ, Van Hilst J, Tsamalaidze L, et al. Technique and audited outcomes of laparoscopic distal pancreatectomy combining the clockwise approach, progressive stepwise compression technique, and staple line reinforcement. Surg Endosc. 2020;34(1):231–239. doi: 10.1007/ s00464-019-06757-3.
  5. Hassenpflug M, Hinz U, Strobel O, et al. Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial). Ann Surg. 2016;264(5):723–730. doi: 10.1097/SLA.0000000000001913.
  6. Balduzzi A, van der Heijde N, Alseidim A, et al. Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review. Langenbecks Arch Surg. 2021 May; 406 (3):597−605. doi: 10.1007/s00423-020-02043-2.
  7. Kwon J, Park SY, Park Y, et al. A comparison of minimally invasive vs open distal pancreatectomy for resectable pancreatic ductal adenocarcinoma: Propensity score matching analysis. J Hepatobiliary Pancreat Sci. 2021 Nov;28(11):967−982. doi: 10.1002/jhbp.853. Epub 2020 Nov 10.

MUDr. David Marek
Chirurgická klinika,
LF MU a Fakultní nemocnice Brno
Česká republika
e-mail: Marek.David@fnbrno.cz

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Článok vyšiel v časopise

Perspectives in Surgery

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