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Practice Patterns and Perioperative Outcomes of Laparoscopic Pancreaticoduodenectomy in China A Retrospective Multicenter Analysis of 1029 Patients

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单位: [1]Huazhong Univ Sci & Technol,Dept Biliary Pancreat Surg,Affiliated Tongji Hosp,Tongji Med Coll,1095 Jiefang Ave,Wuhan 430030,Hubei,Peoples R China [2]Sichuan Univ, West China Hosp, Dept Pancreat Surg, Chengdu, Sichuan, Peoples R China [3]Hebei Med Univ, Dept Hepatopancreatobiliary Surg, Second Hosp, Shijiazhuang, Hebei, Peoples R China [4]Hunan Normal Univ, Dept Hepatobiliary Surg, Hunan Prov Peoples Hosp, Affiliated Hosp 1, Changsha, Hunan, Peoples R China [5]Guangdong Prov Hosp Chinese Med, Dept Hepatobiliary & Pancreat Surg, Guangzhou, Guangdong, Peoples R China [6]Chinese Peoples Liberat Army Gen Hosp, Dept Hepatopancreatobiliary Surg 2, Beijing, Peoples R China [7]Zhejiang Univ, Sch Med, Div Gen Surg, Sir Run Run Shaw Hosp SRRSH, Hangzhou, Peoples R China [8]Xuzhou Med Univ, Dept Gen Surg, Affiliated Hosp, Xuzhou, Jiangsu, Peoples R China [9]Huazhong Univ Sci & Technol, Tongji Med Coll, Union Hosp, Dept Pancreat Surg, Wuhan, Hubei, Peoples R China [10]Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Dept Pancreaticobiliary Surg, Guangzhou, Peoples R China [11]Chongqing Med Univ, Dept Hepatobiliary Surg, Affiliated Hosp 1, Chongqing, Peoples R China [12]Fujian Med Univ, Union Hosp, Dept Gen Surg, Fuzhou, Fujian, Peoples R China [13]Nanjing Med Univ, Pancreas Ctr, Affiliated Hosp 1, Nanjing, Peoples R China [14]Nanjing Med Univ, Pancreas Ctr, Nanjing, Jiangsu, Peoples R China [15]Jilin Univ, Dept Hepatobiliary & Pancreat Surg, First Hosp, Changchun, Jilin, Peoples R China [16]Zhejiang Univ, Sch Med, Dept Hepatobiliary & Pancreat Surg, Affiliated Hosp 1, Hangzhou, Zhejiang, Peoples R China [17]Fudan Univ, Dept Surg, Huadong Hosp, Shanghai, Peoples R China [18]Zhejiang Prov Peoples Hosp, Div Hepatobiliary & Pancreat Surg & Minimally Inv, Hangzhou, Zhejiang, Peoples R China [19]Zhejiang Univ, Sch Med, Dept Gen Surg, Affiliated Hosp 2, Hangzhou, Zhejiang, Peoples R China
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关键词: hospital volume laparoscopic learning curve outcomes pancreaticoduodenectomy

摘要:
Objective: The aim of the study was to analyze the outcomes of patients who have undergone laparoscopic pancreaticoduodenectomy (LPD) in China. Summary Background Data: LPD is being increasingly used worldwide, but an extensive, detailed, systematic, multicenter analysis of the procedure has not been performed. Methods: We retrospectively reviewed 1029 consecutive patients who had undergone LPD between January 2010 and August 2016 in China. Univariate and multivariate analyses of patient demographics, changes in outcome over time, technical learning curves, and the relationship between hospital or surgeon volume and patient outcomes were performed. Results: Among the 1029 patients, 61 (5.93%) required conversion to laparotomy. The median operation time (OT) was 441.34 minutes, and the major complications occurred in 511 patients (49.66%). There were 21 deaths (2.43%) within 30 days, and a total of 61 (5.93%) within 90 days. Discounting the effects of the early learning phase, critical parameters improved significantly with surgeons' experience with the procedure. Univariate and multivariate analyses revealed that the pancreatic anastomosis technique, preoperative biliary drainage method, and total bilirubin were linked to several outcome measures, including OT, estimated intraoperative blood loss, and mortality. Multicenter analyses of the learning curve revealed 3 phases, with proficiency thresholds at 40 and 104 cases. Higher hospital, department, and surgeon volume, as well as surgeon experience with minimally invasive surgery, were associated with a lower risk of surgical failure. Conclusions: LPD is technically safe and feasible, with acceptable rates of morbidity and mortality. Nonetheless, long learning curves, low-volume hospitals, and surgical inexperience are associated with higher rates of complications and mortality.

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基金编号: 81272659 81772950 81773160 81702792 81502633 81602475 81874205 2017CFB467

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出版当年[2020]版:
大类 | 1 区 医学
小类 | 1 区 外科
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大类 | 1 区 医学
小类 | 1 区 外科
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Q1 SURGERY
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第一作者单位: [1]Huazhong Univ Sci & Technol,Dept Biliary Pancreat Surg,Affiliated Tongji Hosp,Tongji Med Coll,1095 Jiefang Ave,Wuhan 430030,Hubei,Peoples R China
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