Pankreas Kanserlerinde Laparoskopik ve Açık Whipple Prosedürünün Karşılaştırılması: Tek Merkez Sonuçları

Year 2020, Volume: 53 Issue: 1, 44 - 50, 31.03.2020

Bayram Çolak , İlhan Ece , Hüseyin Yılmaz Hüsnü Alptekin Ertuğrul Kafalı Serdar Yormaz , Mustafa Şahin

https://doi.org/10.20492/aeahtd.466788

Abstract

Amaç: pankreas
tümörleri için uygulanan laparaskopik prosedür teknik olarak zor olduğu için
yaygın olarak uygulanmamaktadır. Çalışmanın amacı, laparaskopik ve açık
yöntemlerle  proksimal pankreas tümörleri
için ameliyat edilmiş hastaları, ameliyat öncesi bulguları, ameliyat sonrası
bulguları, onkolojik sonuçları ve sağ kalım sürelerine göre karşılaştırmaktır.

Gereç ve Yöntemler:
2009 ve 2017 tarihleri arasında pankreatik rezeksiyon yapılmış olan hastaların
bilgileri toplandı. Açık (TPD) ve laparaskopik total pankreatikoduodenektomi
(TLPD) yapılmış hastalar  bu çalışmaya
dahil edildi. Hastalar, ameliyattan sonra en az 6 ay takip edildi ve tüm
komplikasyonlar değerlendirildi. Komplikasyonların tümü kaydedildi ve Clavien
sistemine göre sınıflandırıldı.  

Bulgular: 62 (%80.5)
hastaya TPD, 15 (%19.4) hastaya TLPD uygulandı. hastaların demografik
bulgularına göre farklılıkları yoktu. TLPD grubunda, kan transfüzyonu, kan
kaybı, hastanede kalış süreleri, yoğun bakımda kalma süreleri, çıkarılan lenf
nodu sayıları açısından belirgin farklılıklar tespit edildi. Ameliyat süresi
TLPD grubunda belirgin düzeyde uzundu. Pankreatektomi sonrası kanama TLPD
grubunda düşüktü. Diğer komplikasyonlar açısından fark yoktu.  

Sonuç: Laparaskopik whipple
prosedürü düşük morbidite ve kabul edilebilir düzeydeki komplikasyon oranı ile
sadece uygulanabilir değil aynı zamanda güvenli bir yöntemdir. TLPD, düşük kan
kaybı, düşük transfüzyon oranı, yüksek sayıda lenf nodu çıkarılması, düşük yara
yeri enfeksiyonu riski ile karakterizedir. Buna rağmen TLPD, ancak seçilmiş
olgularda uygulanabilmektedir.

Keywords

laparaskopik pankreatektomi, açık pankreatektomi, whipple

Laparoscopic versus Open Whipple Procedure for Pancreatic Adenocarcinoma: A Single-Center Experience

Abstract

Background: The laparoscopic approach for pancreas
tumors is not comprehensively approved, due to its technical complexity. The
aim of this study was to compare the perioperative and postoperative results,
oncological outcomes and survival of patients with proximal pancreatic tumor
who underwent laparoscopic treatment (TLPD) versus open procedure (TPD).

Patients and Methods: From 2009 to 2017, information of
patients undergoing pancreatic resection was collected. All patients undergoing
total pancreaticoduodenectomy (TPD) or TLPD were included in this study. The
patients were followed minimum 6 months after surgery and all complications
were analyzed. All complications were recorded and categorised according to the
clavien system.

Results: 62 (%80.5) patients underwent TPD, 15
(%19.4) underwent TLPD. There were no differences in patients demografics.
Significant differences were determined in TLPD group about blood transfusion,
blood loss, lenght of hospitalization, intensive care unit (ICU) stay, number of lymph nodes resected.
Operative time was significantly long in TLPD group. Postpancreatectomy
hemorragy was low in TLPD group. There were no
differences in other complications.

Conclusions: Laparoscopic whipple procedure is not only feasible
but safe, with low morbidity and acceptable complication rates. TLPD is
characterized by less blood loss, lower transfusion rates, improved lymph node
resection, less wound infection. However, the laparoscopic Whipple procedure
can be applied in selected cases. 

Keywords

Laparoscopic pancreatectomy, open pancreatectomy, whipple

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