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Phẫu Thuật Cắt Tuyến Tụy Xâm Lấn Tối Thiểu So Với Phẫu Thuật Cắt Tuyến Tụy Mở Đối Với Các Khối U Nội Tiết Thần Kinh Tụy: Nghiên Cứu So Sánh Theo Điểm Xu Hướng
Tóm tắt
Các khối u nội tiết thần kinh tụy (PNEN) ngày càng trở nên phổ biến với sự phát triển của các phương pháp hình ảnh hiện đại, và phẫu thuật cắt bỏ vẫn là phương pháp điều trị chính. Nghiên cứu này nhằm thực hiện một so sánh theo điểm xu hướng (PSM) về các kết quả phẫu thuật và ung thư học sau phẫu thuật cắt tụy xâm lấn tối thiểu (MIP) so với phẫu thuật cắt tụy mở (OP) cho PNEN. Một đánh giá hồi cứu đã được tiến hành trên các bệnh nhân đã trải qua phẫu thuật điều trị cho PNEN tại Bệnh viện Đa khoa Singapore từ năm 1997 đến 2018. Một PSM tỷ lệ 1:1 đã được thực hiện giữa MIP và OP, sau đó cả hai nhóm được cân bằng về các biến số cơ bản. Chúng tôi đã nghiên cứu 134 bệnh nhân đã trải qua phẫu thuật (36 MIP và 98 OP) cho PNEN. So sánh theo điểm xu hướng giữa 35 bệnh nhân MIP và 35 bệnh nhân OP cho thấy nhóm MIP có thời gian phẫu thuật dài hơn (MD = 75,0, 95% CI 15,2 đến 134,8, P = 0,015), mất máu trong phẫu thuật thấp hơn (MD = -400,0, 95% CI -630,5 đến -169,5, P = 0,001), thời gian nằm viện sau phẫu thuật ngắn hơn (MD = -1,0, 95% CI -1,9 đến -0,1, P = 0,029) và thời gian quay lại ăn uống ngắn hơn (MD = -1,0, 95% CI -1,9 đến -0,1, P = 0,039). Không có sự khác biệt giữa hai nhóm về các kết quả bất lợi ngắn hạn và sự очистка ung thư. Tỷ lệ sống sót tổng thể (HR = 0,84, 95% CI 0,28 đến 2,51, P = 0,761) và tỷ lệ sống không có bệnh (HR = 0,57, 95% CI 0,20 đến 1,64, P = 0,296) là tương đương. MIP là một phương pháp an toàn và khả thi cho PNEN và có liên quan đến mất máu trong phẫu thuật thấp hơn, thời gian nằm viện sau phẫu thuật và thời gian quay lại ăn uống ít hơn, bù lại bằng thời gian phẫu thuật dài hơn so với OP.
Từ khóa
#PNEN #phẫu thuật cắt tụy xâm lấn tối thiểu #phẫu thuật cắt tụy mở #điểm xu hướng #kết quả phẫu thuật #ung thư họcTài liệu tham khảo
Guilmette JM, Nosé V (2019) Neoplasms of the neuroendocrine pancreas: an update in the classification, definition, and molecular genetic advances. Adv Anat Pathol. 26(1):13–30
Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC (2017) Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 3(10):1335–1342
Fraenkel M, Kim MK, Faggiano A, Valk GD (2012) Epidemiology of gastroenteropancreatic neuroendocrine tumors. Best Prac Res Clin Gastroenterol. 26(6):691–703
Lloyd RV, Osamura RY, Kloppel G, Rosai J (2017) Tumours of the endocrine pancreas. WHO classification of the tumours of endocrine organs, 4th ed. International agency for research on cancer, Lyon, France, pp 175–207
Teo RYA, Teo TZ, Tai DWM, Tan DM, Ong S, Goh BKP (2019) Systematic review of current prognostication systems for pancreatic neuroendocrine neoplasms. Surgery. 165(4):672–685
Kasumova GC, Tabatabaie O, Eskander MF, Tadikonda A, Ng SC, Tseng JF (2017) National rise of primary pancreatic carcinoid tumors: comparison to functional and nonfunctional pancreatic neuroendocrine tumors. J Am Coll Surg 224(6):1057–1064
Partelli S, Bartsch DK, Capdevila J, Chen J, Knigge U, Niederle B, van Nieveen Dijkum EJM, Pape UF, Pascher A, Ramage J, Reed N, Ruszniewski P, Scoazec JY, Toumpanakis C, Kianmanesh R, Falconi M, Antibes Consensus Conference participants (2017) ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinology 105(3):255–265
Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103(2):153–171
Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D’Angelica MI, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery MP, Del Chiaro M, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han HS, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou YP, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang SE, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Hilal MA, Besselink MG, International Study Group on Minimally Invasive Pancreas Surgery (I-MIPS) (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271(1):1–14
Zhang XF, Lopez-Aguiar AG, Poultsides G, Makris E, Rocha F, Kanji Z, Weber S, Fields R, Krasnick BA, Idrees K, Smith PM, Cho C, Schmidt CR, Maithel SK, Pawlik TM, United States Neuroendocrine Tumor Study Group (2019) Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: an analysis from the U.S. neuroendocrine tumor study group. J Surg Oncol 120(2):231–240
Belfiori G, Wiese D, Partelli S, Wächter S, Maurer E, Crippa S, Falconi M, Bartsch DK (2018) Minimally invasive versus open treatment for benign sporadic insulinoma comparison of short-term and long-term outcomes. World J Surg 42(10):3223–3230
Han SH, Han IW, Heo JS, Choi SH, Choi DW, Han S, You YH (2018) Laparoscopic versus open distal pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors: a large single-center study. Surg Endosc 32(1):443–449
Lopez CL, Albers MB, Bollmann C, Manoharan J, Waldmann J, Fendrich V, Bartsch DK (2016) Minimally invasive versus open pancreatic surgery in patients with multiple endocrine neoplasia type 1. World J Surg 40(7):1729–1736
Xourafas D, Tavakkoli A, Clancy TE, Ashley SW (2015) Distal pancreatic resection for neuroendocrine tumors: is laparoscopic really better than open? J Gastrointest Surg. 19(5):830–831
Hu M, Zhao G, Luo Y, Liu R (2011) Laparoscopic versus open treatment for benign pancreatic insulinomas: an analysis of 89 cases. Surg Endosc 25(12):3831–3837
Zhao YP, Zhan HX, Zhang TP, Cong L, Dai MH, Liao Q, Cai LX (2011) Surgical management of patients with insulinomas: result of 292 cases in a single institution. J Surg Oncol 103(2):169–174
DiNorcia J, Lee MK, Reavey PL, Genkinger JM, Lee JA, Schrope BA, Chabot JA, Allendorf JD (2010) One hundred thirty resections for pancreatic neuroendocrine tumor: evaluating the impact of minimally invasive and parenchyma-sparing techniques. J Gastrointest Surg. 14(10):1536–1546
España-Gómez MN, Velázquez-Fernández D, Bezaury P, Sierra M, Pantoja JP, Herrera MF (2009) Pancreatic insulinoma: a surgical experience. World J Surg 33(9):1966–1970
Karaliotas C, Sgourakis G (2009) Laparoscopic versus open enucleation for solitary insulinoma in the body and tail of the pancreas. J Gastrointest Surg. 13(10):1869
Gumbs AA, Grès P, Madureira F, Gayet B (2008) Laparoscopic vs open resection of pancreatic endocrine neoplasms: single institution’s experience over 14 years. Langenbecks Arch Surg. 393(3):391–395
Roland CL, Lo CY, Miller BS, Holt S, Nwariaku FE (2008) Surgical approach and perioperative complications determine short-term outcomes in patients with insulinoma: results of a bi-institutional study. Ann Surg Oncol 15(12):3532–3537
Cunha A, Beau C, Rault A, Catargi B, Collet D, Masson B (2007) Laparoscopic versus open approach for solitary insulinoma. Surg Endosc 21(1):103–108
Liu H, Peng C, Zhang S, Wu Y, Fang H, Sheng H, Peng S (2007) Strategy for the surgical management of insulinomas: analysis of 52 cases. Dig Surg. 24(6):463–470
Lo CY, Chan WF, Lo CM, Fan ST, Tam PK (2004) Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 18(2):297–302
Goh BKP, Lee SY, Teo JY, Kam JH, Jeyaraj PR, Cheow PC, Chow PKH, Ooi LLPJ, Chung AYF, Chan CY (2018) Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections. Surg Endosc 32(11):4658–4665
Goh BKP, Lee SY, Kam JH, Soh HL, Cheow PC, Chow PKH, Ooi LLPJ, Chung AYF, Chan CY (2018) Evolution of minimally invasive distal pancreatectomies at a single institution. J Minim Access Surg. 14(2):140–145
Goh BK, Low TY, Koh YX, Lee SY, Teo JY, Kam JH, Jeyaraj PR, Cheow PC, Chow PK, Ooi LL, Chung AY, Chan CY. Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: a single institution experience with 150 consecutive procedures in Southeast Asia. J Minim Access Surg. 2019. [Epub ahead of print]
Dripps RD (1963) New classification of physical status. Anesthesiol. 24:111
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591
Jilesen AP, van Eijck CH, in’t Hof KH, van Dieren S, Gouma DJ, van Dijkum EJ (2016) Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: a Systematic Review. World J Surg 40(3):729–748
Chen K, Pan Y, Liu XL, Jiang GY, Wu D, Maher H, Cai XJ (2017) Minimally invasive pancreaticoduodenectomy for periampullary disease: a comprehensive review of literature and meta-analysis of outcomes compared with open surgery. BMC Gastroenterol. 17(1):120
Lyu Y, Cheng Y, Wang B, Xu Y, Du W (2019) Minimally invasive versus open pancreaticoduodenectomy: an up-to-date meta-analysis of comparative cohort studies. J Laparoendosc Adv Surg Tech A. 29(4):449–457
Dalla Valle R, Cremaschi E, Lamecchi L, Guerini F, Rosso E, Iaria M (2019) Open and minimally invasive pancreatic neoplasms enucleation: a systematic review. Surg Endosc 33(10):3192–3199
Tamburrino D, Partelli S, Renzi C, Crippa S, Muffatti F, Perali C, Parisi A, Randolph J, Fusai GK, Cirocchi R, Falconi M (2017) Systematic review and meta-analysis on laparoscopic pancreatic resections for neuroendocrine neoplasms (PNENs). Expert Rev Gastroenterol Hepatol. 11(1):65–73
Drymousis P, Raptis DA, Spalding D, Fernandez-Cruz L, Menon D, Breitenstein S, Davidson B, Frilling A (2014) Laparoscopic versus open pancreas resection for pancreatic neuroendocrine tumours: a systematic review and meta-analysis. HPB (Oxford). 16(5):397–406
Teo RYA, Goh BKP (2018) Surgical resection of pancreatic neuroendocrine neoplasm by minimally invasive surgery-the robotic approach? Gland Surg. 7(1):1–11
Alfieri S, Butturini G, Boggi U, Pietrabissa A, Morelli L, Vistoli F, Damoli I, Peri A, Fiorillo C, Pugliese L, Ramera M, De Lio N, Di Franco G, Esposito A, Landoni L, Rosa F, Menghi R, Doglietto GB, Quero G, Italian Robotic pNET Group (2019) Shortterm and longterm outcomes after robotassisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors pNETs a multicenter comparative study. Langenbecks Arch Surg 404(4):459–468